Healthcare Isn't A Free Market, It's A Giant Economic Scam

from the destroying-us-all dept

Not long ago, someone I know who had no medical insurance, but who had some serious medical issues, ended up in the hospital for a few weeks. Some procedures needed to be done, but nothing that most people would consider too "drastic." Eventually, the bills showed up, and they were in the range of half a million dollars, for someone who did not have anything close to that. You hear stories about crazy medical bills, but what very few people realize is that the reality of hospital bills can often be orders of magnitude more crazy than what most people expect. Just last week, a friend of mine posted the following image to Facebook, noting that when his normal medical insurance billing statement has room for seven digits (i.e., millions of dollars) something is clearly screwed up.

A few years back, the folks at Planet Money tried to dig in and demystify some of the secrets of medical bills, but that only scratched the surface.

Stephen Brill has a very long, but absolutely gripping, detailed analysis of the insanity of medical billing for Time Magazine. It's a truly astounding piece, that hopefully will open many people's eyes. It will take a while, but find some time to read it, just to get a sense of how totally screwed up the entire system is. I've been working on some other stories about some really sketchy activity on the pharmaceutical side of things, but this article really shines a light on the disgusting underbelly of the healthcare system. As Brill notes, so much of the debate about healthcare is really focused on "but who will pay for these things." But what it tends to ignore is why are the prices absolutely insane.

When medical care becomes a matter of life and death, the money demanded by the health care ecosystem reaches a wholly different order of magnitude, churning out reams of bills to people who can’t focus on them, let alone pay them. Soon after he was diagnosed with lung cancer in January 2011, a patient whom I will call Steven D. and his wife Alice knew that they were only buying time. The crushing question was, How much is time really worth? As Alice, who makes about $40,000 a year running a child-care center in her home, explained, “[Steven] kept saying he wanted every last minute he could get, no matter what. But I had to be thinking about the cost and how all this debt would leave me and my daughter.” By the time Steven D. died at his home in Northern California the following November, he had lived for an additional 11 months. And Alice had collected bills totaling $902,452. The family’s first bill — for $348,000 — which arrived when Steven got home from the Seton Medical Center in Daly City, Calif., was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece. There were also four boxes of sterile gauze pads for $77 each. None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13,225 a day, 12 days in the critical unit at $7,315 a day and one day in a standard room (all of which totaled $120,116 over 15 days). There was also $20,886 for CT scans and $24,251 for lab work. Alice responded to my question about the obvious overcharges on the bill for items like the diabetes-test strips or the gauze pads much as Mrs. Lincoln, according to the famous joke, might have had she been asked what she thought of the play. “Are you kidding?” she said. “I’m dealing with a husband who had just been told he has Stage IV cancer. That’s all I can focus on … You think I looked at the items on the bills? I just looked at the total.”

If we want a real fix to the mounting costs of healthcare (which are a massive drain on the economy), we need to start there. Unfortunately, those who are making out like bandits from this system have tremendous political clout, and they have no interest in letting the easy money go away.

Throughout the piece, Brill repeatedly discusses the "chargemaster," which is basically the internal price list at every hospital, which has no basis in reality whatsoever, but which the poorest patients, and those without insurance, or with limited insurance, are often hit over the head with. Throughout the article, Brill details over and over and over again how hospital administrators and spokespeople all refused to address the chargemaster at all, constantly blowing it off as no big deal, because so few people actually pay the list price. But they completely ignore a bunch of points, including that some patients are charged upfront for these things, and no one is ever told that the prices are negotiable, even though they all are.

What you see is a system where supposedly "non-profit" and "charitable" institutions are raking in massive profits -- while still begging the public for donations, and suggesting that any effort to reign in costs would put people at risk by cutting back on necessary hospital services. At times, these statements are so obviously bullshit, that it's really sickening.

In December, when the New York Times ran a story about how a deficit deal might threaten hospital payments, Steven Safyer, chief executive of Montefiore Medical Center, a large nonprofit hospital system in the Bronx, complained, “There is no such thing as a cut to a provider that isn’t a cut to a beneficiary … This is not crying wolf.”

Actually, Safyer seems to be crying wolf to the tune of about $196.8 million, according to the hospital’s latest publicly available tax return. That was his hospital’s operating profit, according to its 2010 return. With $2.586 billion in revenue — of which 99.4% came from patient bills and 0.6% from fundraising events and other charitable contributions — Safyer’s business is more than six times as large as that of the Bronx’s most famous enterprise, the New York Yankees. Surely, without cutting services to beneficiaries, Safyer could cut what have to be some of the Bronx’s better non-Yankee salaries: his own, which was $4,065,000, or those of his chief financial officer ($3,243,000), his executive vice president ($2,220,000) or the head of his dental department ($1,798,000).

Sometimes these stories make you wonder if some of these "charitable" organizations deserve to be called charities at all:

Mercy Hospital is owned by an organization under the umbrella of the Catholic Church called Sisters of Mercy. Its mission, as described in its latest filing with the IRS as a tax-exempt charity, is “to carry out the healing ministry of Jesus by promoting health and wellness.”.... The overall chain had $4.28 billion in revenue that year. Its hospital in Springfield, Mo. (pop. 160,660), had $880.7 million in revenue and an operating profit of $319 million, according to its federal filing. The incomes of the parent company’s executives appear on other IRS filings covering various interlocking Mercy nonprofit corporate entities. Mercy president and CEO Lynn Britton made $1,930,000, and an executive vice president, Myra Aubuchon, was paid $3.7 million, according to the Mercy filing. In all, seven Mercy Health executives were paid more than $1 million each. A note at the end of an Ernst & Young audit that is attached to Mercy’s IRS filing reported that the chain provided charity care worth 3.2% of its revenue in the previous year. However, the auditors state that the value of that care is based on the charges on all the bills, not the actual cost to Mercy of providing those services — in other words, the chargemaster value. Assuming that Mercy’s actual costs are a tenth of these chargemaster values — they’re probably less — all of this charity care actually cost Mercy about three-tenths of 1% of its revenue, or about $13 million out of $4.28 billion.

While I actually think it's a bit of a cheap shot to repeatedly show CEO salaries, the real issue is how these hospitals can ratchet up the prices with no basis in reality, simply because they know they can do so. Even if they recognize most people don't pay those fees, they still send such bills out there, which creates a tremendous amount of stress.

The stories of obvious overcharging fill the piece and demonstrate a key point in all of this. For all the talk about "free market" healthcare, nothing in our healthcare system is anything resembling a free market. You have truly "captive" customers with almost no price elasticity, combined with a system whereby it's rare for the buyers to actually be the ones "paying." If you were to design the most fucked up economic experiment ever, this might be it. And you can see the results.

Steve H.’s bill for his day at Mercy contained all the usual and customary overcharges. One item was “MARKER SKIN REG TIP RULER” for $3. That’s the marking pen, presumably reusable, that marked the place on Steve H.’s back where the incision was to go. Six lines down, there was “STRAP OR TABLE 8X27 IN” for $31. That’s the strap used to hold Steve H. onto the operating table. Just below that was “BLNKT WARM UPPER BDY 42268” for $32. That’s a blanket used to keep surgery patients warm. It is, of course, reusable, and it’s available new on eBay for $13. Four lines down there’s “GOWN SURG ULTRA XLG 95121” for $39, which is the gown the surgeon wore. Thirty of them can be bought online for $180. Neither Medicare nor any large insurance company would pay a hospital separately for those straps or the surgeon’s gown; that’s all supposed to come with the facility fee paid to the hospital, which in this case was $6,289.

Or how about this one:

His bill — which included not only the aggressively marked-up charge of $13,702 for the Rituxan cancer drug but also the usual array of chargemaster fees for basics like generic Tylenol, blood tests and simple supplies — had one item not found on any other bill I examined: MD Anderson’s charge of $7 each for “ALCOHOL PREP PAD.” This is a little square of cotton used to apply alcohol to an injection. A box of 200 can be bought online for $1.91.

The article is chock full of these kinds of stories. They're not anomalies, nor are they extreme outlier cases. They happen quite frequently. It's standard operating procedure. And, contrary to what most people think, these things don't just apply to those who are without insurance. While insurance may protect against some of these situations, often people discover that their insurance doesn't cover nearly as much as they expected (in part because they never think that bills could possibly be so high. And, while some hospitals are more open to forgiving massive debt for those who are poor, when those who thought they were comfortably in the middle class suddenly realize they may owe hundreds of thousands of dollars unexpectedly, the hospitals are a lot less sympathetic.

Not surprisingly, nearly every hospital that Brill tried to speak to about all this refused to talk about it. Sometimes they gave completely bogus excuses, such as claiming that it's "against the law" to discuss why they charge massive markups on basic items:

Wright said the hospital’s lawyers had decided that discussing Steve H.’s bill would violate the federal HIPAA law protecting the privacy of patient medical records. I pointed out that I wanted to ask questions only about the hospital’s charges for standard items — such as surgical gowns, basic blood tests, blanket warmers and even medical devices — that had nothing to do with individual patients. “Everything is particular to an individual patient’s needs,” she replied. Even a surgical gown? “Yes, even a surgical gown. We cannot discuss this with you. It’s against the law.” She declined to put me in touch with the hospital’s lawyers to discuss their legal analysis.

In one case where he finally got an administrator to speak about the chargemaster rates, the answers were astounding, and either completely mendacious or disconnected from reality (I'm not sure which one is scarier).

“We think the chargemaster is totally fair,” says William Gedge, senior vice president of payer relations at Yale New Haven Health System. “It’s fair because everyone gets the same bill. Even Medicare gets exactly the same charges that this patient got. Of course, we will have different arrangements for how Medicare or an insurance company will not pay some of the charges or discount the charges, but everyone starts from the same place.” Asked how the chargemaster charge for an item like the troponin test was calculated, Gedge said he “didn’t know exactly” but would try to find out. He subsequently reported back that “it’s an historical charge, which takes into account all of our costs for running the hospital.”

It's fair because we charge absolutely everyone insane amounts that have no basis in reality, and which we mark up ridiculously -- and then we offer discounts to many, but certainly not all patients. This answer is bullshit. Not everyone starts from the same place, but even if we grant that ridiculous claim, having everyone start at insane prices doesn't make it fair. It still makes it a giant scam.

And, of course, the hospitals know they're getting away with all sorts of crap here. Even when they're talking about things like Medicare, where the government is the "buyer," the situation is crazy. While the hospitals, pharma companies and others complain that government supported healthcare artificially deflates revenue and limits their ability to provide patient care, the article goes into a fair bit of detail about how that's hogwash, and the hospitals (and doctors) are massively profiting off of the taxpayer -- sometimes in completely cynical ways.

“One of the benefits attending physicians get from many hospitals is the opportunity to cruise the halls and go into a Medicare patient’s room and rack up a few dollars,” says a doctor who has worked at several hospitals across the country. “In some places it’s a Monday-morning tradition. You go see the people who came in over the weekend. There’s always an ostensible reason, but there’s also a lot of abuse.”

If you know even the slightest bit about basic economics, the deeper you look at this system, the more and more you realize how insane it is. Nearly every single incentive is skewed, often dangerously so. The system is more or less designed to be abused, while making it increasingly difficult for people to get reasonable care. I'd argue that it may be worse than if you asked a bunch of economists to design the worst possible system of incentives.

And we're more or less stuck with it. For all the debate and the fight over reform, the reform package we got really did next to nothing to address any of these kinds of underlying issues. And this has nothing to do with silly claims of whether or not it's "socialist". The entire healthcare system, before and after the recent health reform, does not resemble anything even remotely close to a free market system. And, while there are some who argue that healthcare itself shouldn't be subjected to free market forces, but rather towards what provides the best care, it's not like the system is designed to match up with that belief either.

The system is completely broken. In researching other aspects of the system, I'd already come to the conclusion that it should be scrapped entirely, with something completely different put in its place, but this article just helps take that belief to another level. And, the scary thing is that the chances of that happening are basically zero. We're stuck with this system, in part because the economic incentives are screwed up so much that it's ripe for widespread abuse. And when you have so many billions of dollars flowing, with a small group of folks profiting massively from that, there's simply no chance they'll allow for any real changes.

And, the really scary thing is that the bits I've talked about here really only scratch the surface of Brill's overall article. And, his article really only touches on one part of the problem. It is a key part of the problem, but it's still just one part. And each of the other parts tend to look equally insane when you start digging deeper. We are in the middle of the most horrifying economic experiment ever constructed with our healthcare system, and it's only impacting almost everyone's lives. Oh yeah, and there's no real interest in taking on the actual problems.

It's what you get when capitalists control a market...

without being tempered by humanism.

Basically, you've mistaken notions of what "capitalism" is -- just a term for economic tyranny by plutocrats. They'd happily grind you into hamburger to feed their dogs if could be made "legal", meaning most people would meekly obey.

All the good things in your own life that you associate with the term "capitalism" have been hard won by fighting back plutocrats and their inherited privileges.

Repay in small amounts

I knew someone who was in the same boat. He was in an accident and comatose for weeks. Spent a few months in the hospital. He never openly told me how much is final bill was, but he only laughed and told me he could only afford $10 a month. They threatened him, and even took him to court. But he proved that since he had no assets and other bills making only a small amount, it was all he could afford. Apparently he's been doing that for years. You just can't get blood from a stone. So why even worry about paying it all back? Just pay a puny amount each month until they agree to lower the total amount.

Re: It's what you get when capitalists control a market...

It is the first time I don't want to just report your comment.

I can't argue why and can only make assumption but with that type of revenue, it would seem like there would be more competition. Any new hospital could open up their doors and charge half those costs and still make a killing. I am thinking that capitalism isn't what is causing the outrageous pricing. It would seem like a combination of government laws and regulations that prevent new competition in the market. Once government gets involved and sets up artificial barriers, it skews the market.

So WHO do you finger as the criminal, Mike?

You've stated it's a "scam", but this seems as close as you get to saying WHO'S doing it: "We're stuck with this system, in part because the economic incentives are screwed up so much," -- Oh, it's disembodied "economic incentives". You even put "economic" unnecessarily into the title.

So after actually reading ALL your wall of text, I can't find any substance. You're variously ranting like a "conservative" over insane gov't rules and payouts, and mildly scandalized like a "liberal" over arbitrary pricing, puzzled as "libertarians" always are when "markets" aren't actually "free", but you don't actually even try to fix blame: your last three paragraphs are generic ranting about problems without any actual actors responsible for them.

The criminals are THE RICH, Mike, as always. They control the gov't and the hospitals AND the insurance companies, practically own the doctors through monopoly on schooling and licensing, and through another monopoly with lawyers, control every aspect of legalities.

There are two problems with healthcare. First, capitalism/a free market depends on consumers making rational choices. There is no choice in relation to healthcare other than to choose to live. You can only say "no" to having your broken leg fixed for so long.

Second, third parties are paying for it, so there's little oversight in keeping prices in check. If we had to pay for each item on a medical bill, we'd complain. There would be rioting. But because someone else is paying, we just shrug and pass it on.

It's not just the hospitals and med providers

It's the insurance companies as well. The overhead to run a private insurance company in the US is about 30% of revenue. The overhead to run Medicare in the US is about 3%. Both organizations do the same thing - pay for medical care services, yet the overhead in percentage terms is 10 times as much for private insurance companies.

Some years ago the founder of one of the big health insurance companies retired with a $350,000,000 going away present. I assume he also got away with a lot stock that had appreciated in value during his tenure there. None of that money paid for any health care - not a single physical exam, not a single minor surgery, not a single life saving procedure needed due to an accident, it paid for nothing except for a nice retirement lifestyle. Who paid for that bonus? Likely the insurance company's clients who had money deducted from pay checks and the employers of those clients who paid it as an employment benefit. You might think the salaries paid the CEOs of big enterprises in the US are outrageous, the health care business is just the same.

Pretty simple: The reason health care services are so expensive is that there's 90 layers of paperwork and bureaucracy between those that provide and charge for the services (doctors, etc) and those who receive and partially/wholly pay for the service (patient).

All those layers make it insanely easy for the providers to jack up the prices to whatever they think they can get away with. And patients take the attitude of "Who the fuck cares what it costs? I've got health insurance!"

ObamaCare

Disclaimer: I work for a large medical insurer.

When they were discussing the Affordable Care Act prior to it's passage many people I work with were appalled at the discussion. Insurance was made out to be a robber baron villain while nowhere did you see any discussion of where a dollar of health care costs went to. Truth is most medical insurance companies work on about 2% net profit margin and are required to pay out in claims $0.85 of every dollar collected in premiums. Contrast with the pharma companies who operate on 24% profit margins. As noted in the post large insurance companies don't pay these ridiculous chargemaster fees and as a result most peoples insurance premiums are much much lower than the would be otherwise. In this context insurance companies are more like Robin Hood than Robber Baron.

But, the heart of the problem is in fact caused by the insurance companies. They look at the rates they contract with health care providers as a competitive advantage between each other and try hard to keep this info private. In what other walk of life do you buy a good or service with no ability to find out the price ahead of time? Imagine if you couldn't know anything about prices before buying a car. Hell, I'd come home with a Ferrari every time.

A simple chart showing where each dollar of health care spending ends up along with requiring published price lists (by insurance carrier as well as without insurance) would go a long way to fixing all this. A little sunlight makes a good disinfectant.

Re: It's what you get when *CRONY*-capitalists control a market...

"Crony-capitalism", sure.

Howver, this is most certainly not the result of "capitalism" (defined as an economic system based on the respect for self-ownership derived property rights and voluntary exchange, in a market free from government force/aggression).

In a voluntary market, prices are made up of hundreds of thousands (if not millions) of voluntary exchanges occuring constantly. Thus providing an immense amount of knowledge that no one person, or bureaucrat, could ever know. As soon as State force enters the equation (i.e.,"regulation"), said knowledge is corrupted and perverts natural market incentives.

The current healthcare prices are forced by government through Medicare, keeping said prices insulated from natural voluntary market forces. They have no incentive to lower prices and compete since the Medicare prices are back by State aggression/violence (or threat thereof).

I highly recommend the two following articles to gain further understanding into why the healthcare industry is the way it is (one article touches on the history, the other on why prices are so high).

. . . while independent doctors are closing their shops

I live in the retiree capital of the US and we have no shortage of patients for doctors to care for.

Nevertheless, in the last decade over half of our independent physicians (primarily GPs) have closed their practices to join larger medical groups, move from the area or just retire early. They've found it increasingly unprofitable to practice traditional medicine.

A predictable exception are surgical specialists, most of whom work as an attending physician at a local hospital.

Another relevant note is that medical service providers here are being reimbursed at increasingly lower amounts - from both government and private sector insurance.

I have two customers that are established local service providers. One believes it will - unavoidably - become unprofitable within the next 18 months.
The other is realistically unsure of it's future and hopes to survive through streamlining the organization.

These are community driven companies.
They provide services that are in demand and they are immensely responsible with their operations.

But with new cuts from Medicare, Medicaid and private insurance coming each quarter, they (like our local physicians) are finding it less and less profitable to continue.

Re:

it's a conflict of interest because it means the doctor and nurses are forced to think about more than the patient's health. They also have to think about the bottom line.

For example, in the UK, where we have "socialized" healthcare (which, considering we have people coming over specifically to use our healthcare, can't be that ba you don't get many of the abuses in the article. There are other problems ( some drugs are too expensive for their benefit, for example, though the cost has to be pretty obscene (I think the rule is if it is an ongoing treatment, it cannot cost more than 20k per year.))

is there actually any industry or service in the USA that doesn't use the same ploys as the entertainment industries? they all seem to use the ' we need more help from the government, we need more donations, we need more legislation, without these jobs will be lost, services will suffer, hospitals (film studios) will close, ex- staff (artists) wont be able to feed and cloth themselves or their families, patients will die!

and as usual, a very small number of elite, powerful people are creaming in a vast fortune off the backs of others!

Re: ObamaCare

One of the reason profits are so small (2%) is that the overhead is so high. Pay the same salaries for similar jobs as are paid by the government, and either private insurance companies would be making 32% profits or cut premiums to keep profit at 2%. Your statistics are bogus when you don't include overhead costs which includes the extraordinary salaries and golden parachutes that are paid. If you're a true nonprofit you pay no taxes as well.

In the United Kingdom where I live, health care is made as fair as possible for everyone with the NHS, and it is the only moral perspective to really have. There are some situations where having a free market/capitalist perspective is useful and other situations where having a more socialist perspective is useful (so being on the extreme end of either these perspectives is a bad thing) - here, a socialist perspective is needed.

The question is simple: should a person's vital health be discriminated against based on his or her wealth? The answer has to be "no", because the desire for profits - and the growth of unaccountable corporatism due to the "consumer" not having much of a say in the matter, causing corporations to run away with whatever amount of profits they like - is always trumped by the moral need to give people a fair fighting chance against preventable illnesses.

The free market cannot solve everything, despite what we are often told. If the fire-truck refuses to arrive due to a company's incompetence rather than the government's incompetence, nobody can really be held to account. If the fire "company" can say "no deal" because of their right to refuse to trade, they cannot be in a position of power as such. The same has to apply with police forces for parallel moral reasons, as well as education - and the more you examine it, the more that health has to fall into this category too.

Contrary to how it must be perceived, not ALL health matters are socialised here in the U.K. Certain prescriptions still have to be paid for (the non-vital ones such as mild skin treatment, etc). So we are fairer than most would believe.

And we also do not restrict the existence of private health care if people wish to seek it. If they do even after paying NHS tax, you cannot and should not stop them - but they must pay their fair share initially to the NHS as a matter of moral principle.

Re:

I disagree with your first point. After all, it could apply just as well -- or better -- to food. And if the doctor wants everything I own to set my broken leg, I'll ask a friend to splint it. If I had heart disease and would surely die without a procedure that would cost me my entire fortune, I'd seriously consider just leaving it all to my heirs instead.

I agree with your second point, and I'll add a third: regulation. There is a law against practicing medicine without a license, you can't get a license without a degree, and a degree costs six figures (and your youth, and the risk of failure).

Oh, and a fourth: litigation. Medical malpractice has more to do with lawyers' oratory and juries' emotion than any logic, so it's hugely expensive. Therefore so is malpractice insurance, therefore so is any inherently risky practice such as thoracic surgery or obstetrics.

Re: Re:

it's a conflict of interest because it means the doctor and nurses are forced to think about more than the patient's health. They also have to think about the bottom line.

Who's bottom line do they have to think about? The hospital's? I'm don't understand why a doctor or nurse needs to give a frak about making sure the hospital is charging enough. Do you think the cashier at the Tesco cares what they're getting for a Snickers bar?

There is no incentive to lower prices

We've all heard of or experienced the ridiculous prices charged by a hospital vs. the much smaller amount acutally paid by an insurance company (e.g. The hospital bill for a procedure is $10k, but the allowed amount stipulated by an insurance company is only $4k. The hospital gets the $4k and everyone is happy; the additional $6k just disappears. Meanwhile, if you don't have insurance, you're on the hook for the entire $10k)

There are 2 reasons for this:
1) The hospital at the end of the year gets to write off the difference between what it charged originally and what it got paid as a loss. So in the example above, the hospital will write $6000 off on its taxes.
2) The insurance company (at least those used as manager for large companies who fund their own insurance plans) will go back to its client and say, "Look at all the money we saved you! Instead of having to pay $10k for this procedure, you only had to pay $4k!" The client company then happily gives the insurance company a percentage of the 'savings' as a bonus.

Because of these 2 reasons, there is no incentive for hospitals to charge less for procedures that that know don't cost anything close to what they're charging - both the hospital and the insurer end up making money on the overpricing.

The entire healthcare and health insurance industries need to be dismantled and rebuilt.

Re: Re: ObamaCare

Wrong! I did include that information. By LAW insurance companies must pay out in claims 85% of what they take in premiums. Let's put that another way. Insurance companies must have at most 15% administrative overhead. That includes all facilities, equipment and SALARIES. As a comparison Walmart (hardly a high margin business) ran 18.3% to 19.7% from 2006 to 2012.

Back in October, I fell while away from home, hit my head and was knocked unconscious. Someone called 911 and I was taken to the hospital where I spent two days under observation. A staff member helped me apply for Medicaid. I don't know what the hospital bill itself was since they submitted it directly, but the separate bill for the doctors was $1,600+ and the ambulance bill was $1,400+. Of that, $1,000+ was the "base fee" with the mileage tacked on at $16 a mile.

A few years ago, I spent a few hours in the hospital while they ran tests on me and the total bills for that were about $5,000.

If I didn't know any better, I'd think they actually want the poor to die off, leaving just the rich.

Medical "Vacations"

And these costs are why our family, when faced with a hospital stay, pays a few hundred dollars for tickets to Costa Rica, where for 10% of the price, we receive 10 times the care we would have gotten in the US. Many hospitals there take Blue Cross, which pays about half the bills, as well.

I've also been hospitalized in Thailand, where I received first-class medical care for even less than Costa Rica. Ten days in the hospital, a truly gorgeous room with a bed for my husband, excellent food, two surgeries, four specialists...and the total bill was less than $5000. BC/BS picked up most of the tab, including translating the medical files. The doctors, by the way, mostly trained at Stamford Medical School.

When we need emergency care here, we have a family care doctor who takes no insurance and charges $50 a visit.

Many places--India and Singapore, for example--will arrange the entire process for you on-line, including speaking with a specialist who will route you to the best hospital for your needs and arrange for transportation. Google Medical Vacation and prepare to be stunned.

Americans should get over their fear of foreign doctors and seek extensive care elsewhere.

Re: Re:

And yet it's still universally acknowledged as being better than the American system, at least for the 99%. They can and should improve their system, but they'd be improving a one that's already superior.

Re:

Re: ObamaCare

I agree, at least partly with what you are saying.

I think that Health Insurance increases costs by increasing most peoples 'ability to pay'.

Obamacare will also create a shortage of doctors (especially general practitioners, of which there is already a shortage), because it will dump millions more into a system, that they otherwise would not utilize.

In addition to this we have a lot of boomers coming to the point in their life when they will need increased healthcare.

So we are entering a time of increased demand, decreased supply and a greater ability to pay. This is a recipe for record high prices.

Re: Re: It's what you get when capitalists control a market...

you are correct. a few years back there was a doctor in.. michigan or illinois (I think) that opened up a clinic and charged actually personally affordable rates.
the law stepped in because he was charging too little, and they forced him to change things.
he used to work at a hospital but saw the craziness and just wanted to help people.
bureaucracy and legislation get pretty crazy.
further, there are many govt hurdles to overcome to set up a hospital, both state and federal wise.
with the corruption in place, your 'reasonable' hospital might not even get approved by the powers that be.
or delayed with so many costs that it's easier to shut down.

The article doesn't take it far enough.

It doesn't ask Why in relation to the ever rising price of medical care.

Why? EMTALA for one. This law forces all hospitals to treat any person regardless of means to pay. And lets face it, no one is going to work as a doctor for no pay because becoming a doctor is an extremely expensive proposition. More on that below. By forcing the hospitals to take all patients, you set up a system where the demand is ever increasing and then the hospital is forced to recoup the expense of non-payers somewhere. They are legally allowed to shift that cost onto other patients and their insurance. They do this by jacking up the costs of the simplest items. $77 for gauze pads, for example. In any other industry this is illegal but hospitals are given an exemption for this (i can't recall the law that provides this exemption. It might be EMTALA and it might not be.) Since these costs can be shifted elsewhere, the hospitals make free with it and the insurance companies pay for it. That's why you have an 8.9% annual increase in healthcare while inflation is at less that 5%. Thats also why your insurance rates for medical coverage are going through the roof, in spite of the Affordable Heath Care Act.

Add to this our education system following the same practice. Anyone can get a loan regardless of the means to pay it back. And they can't escape the loan even with bankruptcy. So, as a university with ever increasing demand, how do you cope? You raise your tuition. But the government will allow any student loan regardless of means to pay it back - so demand keeps increasing. Since demand keeps increasing so do the prices. Its a vicious circle that has no end.

So then you take the doctor who just graduated med school and has 500k of debt. How does one pay back that much money? Well, charge a lot for your time. Push to make more per hour every single year. And this is allowed by the insurance companies. Medicare obviously limits this earning ability but it also makes the doctors increase their prices for non-medicare patients even more. Yet another vicious circle that has no end.

Except the end is coming for both. With education, the next bubble is approaching. We have far far too many new graduates not able to find work. Too many lenders not getting a return on their investment. Eventually those lenders are going to go bankrupt because the revenue stream they need to survive, founded on those loans being paid back, is no longer a stream, but a trickle. And once again, the tax payer will have to bail out a financial institution that is following rules setup by the government. This is the same situation as the housing bubble all over again. With healthcare, the system can only support such geometric increases for so long before it collapses. People are deluding themselves in thinking it won't. Geometric functions in the real world are not supportable and 100% of the time reach a point where they collapse.

Can anyone tell me what the result of an industry collapsing the accounts for 25% of our GDP?

Re: ObamaCare

While I actually think it's a bit of a cheap shot to repeatedly show CEO salaries...

Mike, I would tend to agree with you on this when the shots are being taken at for-profit businesses, but when the institution is claiming to be a tax-exempt charity I think we actually need a lot more of this type of transparency. It is absolutely disgusting that the CEO of a non-profit is making a multi-million dollar salary! How many people could have been provided with medical care if that CEO took a salary draw that was reasonable? Now based on those chargemaster numbers that salary would have only covered a few paper cuts and maybe a splinter or two, but the principle remains the same. It's clear that the government will do nothing to remedy this situation, so maybe a little more disclosure of hospital admins pulling in several millions while people's children are dying because they can't afford treatment might spark enough public outcry to force some true reform.

Re: Re: Re: It's what you get when *CRONY*-capitalists control a market...

Re: It's what you get when capitalists control a market...

The US HealthCare system is controlled by overbearing, monopolistic laws (McCarran–Ferguson Act, Medicare, Medicaid & ObamaCare) that stifle the Free Market. The structural influence of “The State” ends up being harmful to all - no 16oz drinks in NY, can only see Govt monopoly doctors.

Only a Commie loving, Mao praising, Stalin worshiping, N. Korean cheerleader would have such a low option of REAL Capitalism. After all, it was Mao and Stalin that DID grind 100M+ people into hamburger to feed their dogs.

Let’s open it up to Real Competition, Transparency and reduce the Legal Barriers to Entry. The Govt Monopoly is fucking it all up. Central planning never works because No One can anticipate what will really happen.

Cronies & Monopolies are the problem, not the Capitalists who fight against the prior mentioned all day long.

Re: Re:

I'd like to know: how much influence does the healthcare industry have over the government in the UK?
As the TIME article says, over here they've spent billions lobbying to keep the government seeing things their way. Which is a ridiculous thing for supposedly non-profit organizations to do, but as long as the general public isn't aware they're doing, they can get away with it. (Hopefully these articles will raise awareness a bit.)

This is why every other 1st world nation has either the government act as the insurance company for all it's citizens (like Canada, where Americans get cheap prescription drugs, while simultaneously claiming Canada's healthcare system is horrible), or makes all the doctors and hospitals part of the government (Like much of Europe).

Obamacare will help a few of the problems (like costs of providing healthcare to people without insurance being shifted to everyone else with insurance to make up for the unpaid bills for them), but it largely keeps the system the same.

The problem is the US's healthcare system costs way too much (other 1st world nations don't spend anywhere near as much money on healthcare as us) and STILL delivers worse results then other 1st world nations (The US ranks near the bottom in most ways of defining who's healthier, such as longer lives, fewer hospital stays).

Health care is one area that the free market just doesn't work for, because of the reasons outlined in the article.

Health insurance is the same thing, in order to get good enough discounts from hospitals you have to have more people covered under your health insurance to give you more bargaining power. In order to get more customers you need a reasonable/low healthcare premium. Such a system favors there being just a few big players and little competition (and indeed, most states have 1 to 3 health insurers who cover a combined 90%+ of the people with health insurance in the state).

Re:

I'm Canadian and it's not a good feeling to look down on American healthcare. I know that there's pressure to bring the awesome American healthcare system to Canada. I don't think Canadians would ever allow that (anyone attacking Canada's public healthcare system is basically unelectable thankfully), but it's still a frightening thought.

Also, the American healthcare system puts pressure on our system. Doctors will often move to the U.S. to make more money, we have difficulty getting affordable drugs and medical equipment when the American system pays so much, etc.

Re: Re: It's what you get when capitalists control a market...

Once government gets involved and sets up artificial barriers, it skews the market.

Plainly not true - since most european countries have FAR more government involvement than the US and most of these countries are able to provide free treatment with similar outcomes to the US and spens a smaller proportion of their GDP doing it.

The problem is not the fact that the government is involved with healthcare - it is the fact that the healthcare companies are involved with the government.

It's a complex problem

Health insurance, by its nature, isn't going to work. Insurance works when lots of people pay into it and very few actually use it. For example, many people pay homeowners insurance, but very have disasters where they need to collect.

But most people want to use health services at some point. They think they should be able to pay into the system low rates, but then have access to health care as they need it. If it works the way insurance should work, lots of people will pay in order to fund the health needs for a very few. One way to do that is to have high deductibles so that for routine treatment everyone pays out of pocket and then insurance only covers the big expenses. But you still need lots of people paying into the system to generate the money to pay out for the few. That has been the principle of requiring people to have insurance. To create that pool of money to draw upon.

That still doesn't get around the idea that the poor don't have enough money to pay those basic out-of-pocket fees. So you either don't treat them or you find ways to cover them using government funds, charity, or some other system based on a sliding scale.

What health care needs to address are several issues:

1. Bringing down the overall cost of services.

2. Getting people to skip health care services they don't really need (unless they want to pay for it themselves).

3. Getting people to pool funds (e.g., insurance, co-ops, government-supported services) so that there is money in the system to cover the expenses that are beyond most people's ability to cover themselves (e.g., cancer, organ transplants, accidents).

4. Improved lifestyles to make us healthier (e.g., should the system have to pay for the poor health of smokers?, of those who refuse to wear motorcycle helmets?).

5. Better environmental protections (so we aren't exposed to chemical/physical hazards which make us sicker).

Re: Re: It's what you get when capitalists control a market...

Let’s open it up to Real Competition, Transparency and reduce the Legal Barriers to Entry. The Govt Monopoly is fucking it all up. Central planning never works because No One can anticipate what will really happen.

The market doesn't work for healthcare because:

1 Most people who need it are effectively under duress and unable to make reasonable consumer choices at the point of need.

2. Only a tiny minority can afford to pay the real costs of major lifesaving treatment at the time of need. The costs need to be spread across lifetime and across the population.

You can have insurance like the US and end up with all the overcharging and bankruptcy that goes with it or you can be rational like the UK and have a national health service that costs less than half as much and delivers the same or better outcomes for almost everyone.

Those who believe that the free market can provide healthcare in the modern world are fantasists.

Re: Re:

Noah, all you are saying is: In the U.S. the government is a significant player in healthcare, and healthcare is insane (as the article shows). Then you conclude: therefore the insanity is caused by the government.

Textbook example of illogical thinking. You have provided no basis to blame the government here. I'm not saying there isn't one, I'm just saying your conclusion is completely unsupported by your premise, especially given that you are replying to someone saying that a complete government-run system in the UK is excellent.

Re: It's a complex problem

I'll add that for-profit insurance companies don't want to cover people who are sick or will be sick. The free market system encourages insurance companies to avoid covering people it thinks it will lose money on.

What we've had in the past is what is called a death spiral. You provide everyone with low rates to get them to sign up for your health insurance rates. Then after a year you significantly jack up the rates and everyone bitches. The healthy people leave and the same company approaches them again with low rates. The sick people are stuck with the expensive insurance or no insurance because now that they have pre-existing conditions, no one else wants to cover them.

That's the problem with our system: no profitable way to provide care for sick people, especially those without money. It is a societal question that hasn't been fully addressed in the US. When publicly funded health systems try to develop priorities which don't pay for expensive treatments which will not prolong life, people scream death panels. But private insurance companies do it all the time. They deny services, they don't sign up sick people, and so on.

Another problem is that as private health insurance gets more expensive (and it was doing this long before Obamacare), fewer people can afford it. So fewer people pay into insurance pools and it gets that much more expensive. Our country was heading for an unsustainable health care system without Obamacare anyway.

Now, we could go back to a system where everything is paid on a cash basis or credit, which is what we did before health insurance. But most people would not be able to afford most of the modern medical procedures, like cancer treatment, organ transplants, dialysis, etc. While costs would come down if there was no health insurance or government systems, they probably would not come down sufficiently to become affordable for people living paycheck to paycheck. And people probably wouldn't be putting money aside for the day when they needed to cover unexpected health expenses.

Re:

Rather than direct price/salary regulations (which inevitably backfire), what about a law that allows patients to challenge any fee a medical group charges if they can find the same thing for less than half the price they were charged? If proven right by an independent arbitrator, the medical group would have to pay the patient 10x the fee charged and reasonable arbitration fees.

Re: Re: It's what you get when *CRONY*-capitalists control a market...

If you think Medicare is keeping prices insulated from natural market forces, methinks you did not RTFA. Medicare looks at what stuff actually costs a health care provider (including administrative fees and such) and refuses to pay more than that value.

Also, health care is not something I want subject to pure market forces. It is an inelastic good and therefore it's very easy for health care providers to gouge their customers. That's how you end up paying $1.50 for a tablet that costs $0.015 at a drug store.

Re: Re: Re: It's what you get when capitalists control a market...

"you are correct. a few years back there was a doctor in.. michigan or illinois (I think) that opened up a clinic and charged actually personally affordable rates.
the law stepped in because he was charging too little, and they forced him to change things."

Specifics, please?
At least the town or city and date (within a year)?
Othewise this is like Michelle Bachmann's "A woman (who I never saw before) came up to me and told me a vaccination gave her daughter autism" story

Re:

Agreed, except I would take it further. Why's it "a cheap shot" to show absurdly high CEO salaries in the first place?

A highly skilled, experienced worker, working full-time, can expect to make a little under $100,000 with the right skillset, and that's pretty high-end. When you have people in charge who are making 1 to 2 orders of magnitude beyond what they're paying the most skilled of their employees--the ones who are actually generating the revenue--is it not fair to ask what they're doing to deserve such compensation?

Are they working harder? I'd expect to pay someone 10x as much if they're working 10x as hard... but I don't see any CEOs working 400--4000 hours a week, seeing as how there are only 168 hours available to choose from.

So then, why should it be considered "a cheap shot" to call attention to such absurdities?

Re: Re:

Re: Re:

For the 1st point, if you call that choices, then can't argue with you there.

For your 3rd, are you really suggesting we do away with regulations like the one which needs license to practice? Don't you think for that particular problem, the problem lies on why the degree cost six figures (educational cost problems) instead?

For your 4th point, are you suggesting that we do away with liability litigation, cos that's what those insurance supposed to protect the practitioners from? Are market forces enough to deter practitioner from malpractice, given most people I think agree with Ima's 1st point.

Back on Ima's post, I do think the 1st step on "fixing" the system is addressing the 2nd point, creating awareness about the prices. Not just for the patients, but the doctors as well.

For example, my mom got heart problems, and for prescriptions, her doctor always ask do we want patented or generics and explain the price differences. We use generics, and as far as I can tell, they're working fine.

Re: So WHO do you finger as the criminal, Mike?

"The criminals are THE RICH, Mike, as always.
They control the gov't and the hospitals AND the insurance companies, practically own the doctors through monopoly on schooling and licensing, and through another monopoly with lawyers, control every aspect of legalities."

The first intelligent thing out_of_the_blue has ever said!
But it beggars the question as to why the boy normally shills for them...

Re: Re: Re: ObamaCare

Re: Re:

I agree entirely. Pointing out executive pay - for CEOs and other officers - is not a cheap shot at all.

As you said, CEOs aren't the ones actually generating any wealth. Their employees are generating it.

The ratio of CEO to median worker pay used to be reasonable in this country. Now it's totally out of hand. But heaven forbid we talk about this because it's "class warfare" or "what the market will bear". If we had reasonable tax incentives then I don't think I'd have as much of a problem with high CEO pay, but instead we have upside-down tax incentives where highly-paid officers pay lower tax rates than the median worker.

Re: Re: It's a complex problem

A few corrections.

1. Under ObamaCare pre-existing conditions are gone. So you can throw that one out the window.

2. Low rates jacked up after a year are a myth. Most people insured in the USA today are insured through their place of employment with uniform rates no matter how long they've been employed or how old they are. Now this method of insuring through work is a nasty mess in and of itself. Everyone should self insure just like car insurance. The current group system allows big companies like Walmart to get a great deal while Joe the CPA and his 2 man office get the shaft. But the problem you are implying just doesn't exist.

3. What you kind of slide around but don't really touch is that 80% of health care dollars are spent on end of life care. (I'm using that term loosely here.) It's been shown that there are better outcomes with hospice care at end of life at much less cost when compared with hospital care. But discussing this always brings on the screams of "death panels". Given that in my 20s I don't really need insurance why should I pay for it? In my 80s however I'm going to cost far more than my premiums will cover. This is the one thing ObamaCare will help with.

4. One thing I always note is that my dog doesn't have health care insurance and he gets better care than I do at a price that doesn't bankrupt me. That includes one very sick dog with cancer that was stabilized for almost a year and that I had to put down a little over a year ago. If the vet can manage it why can't the doctor? The only two reasons I can think of are greed. Greed on the part of the medical community and greed on the part of the malpractice system.

This is exactly why, I believe everyone should start doing their on healthcare, not with the idea to replace the actual system today in a short term but to prepare the road ahead for real change.

If the government won't do it or is incapable of doing it, people should take care of their own health by any means they can.

Learn how exams are done try to replicate the processes, find new suppliers, experiment with community funded clinics, make medicine and instruments, anything you can take away from the hospital to charge you is something you are regaining control over it.

Re: Re: Re: Re: ObamaCare

So the doctor should work for free? Mind you, I don't completely agree with the salary that doctors make but given what goes into becoming a doctor and the life style that it requires I certainly wouldn't deny them a good wage.

Our system is based on people doing things because they make a profit and there's nothing wrong with that. Where it becomes a problem is when the system is rigged to allow the kind of abuses that Mike detailed in his post.

Re: Re: Re: Re: ObamaCare

I am no fan of insurance companies but not for the reasons most people think.

To be fair Insurance companies don't profit off sick people. They are basically profiting by putting people together in pools and then setting rates so that that particular group makes them money. They try to have more healthy than sick people in a group. The more sick people in the group the higher the rates.

All doctors 'profit' off of sick people. Doctor's need to make a living too, just like nurses and other healthcare professionals. I don't think making a profit off of sick people is wrong. Making an obscene profit certainly is though and many drug companies, health networks... have turned healthcare into a money machine.

My problem with insurance is once the majority of people carry insurance, it artificially raises the ability of the consumer to pay. It also means that the true cost is hidden from the consumer. This is a recipe for spiraling costs because the consumer doesn't really bear the cost. It gets hidden by the insurance, the cost of which is hidden because much of it is normally paid by the employer and never shown to the employee, many are on on government subsidized health care...

And the Court Documents/Disposition, which the Plantiff desired sealed. From the story- "During the deposition, Sammons said his hospital charged patients $69 per minute of emergency room time and marked up prices for some medical supplies at a rate of 3 1/2 times what they cost the hospital. He was asked how the hospital decided on its pricing."

The attorney wanted the Disposition from the CFO sealed, but the prevailing party thought it was more important to be made public.

Re: Re: Re: It's a complex problem

1. Under ObamaCare pre-existing conditions are gone. So you can throw that one out the window.

That's been one of the big selling points for it. But I am talking about how for-profit health insurance has been done up until this point.

2. Low rates jacked up after a year are a myth. Most people insured in the USA today are insured through their place of employment with uniform rates no matter how long they've been employed or how old they are. Now this method of insuring through work is a nasty mess in and of itself. Everyone should self insure just like car insurance. The current group system allows big companies like Walmart to get a great deal while Joe the CPA and his 2 man office get the shaft. But the problem you are implying just doesn't exist.

Actually it did exist. I saw it in action and then researched it and that's where I read about "death spirals." I have been buying my own health insurance for 20 years. I was using a plan that did exactly what I described. It was low and then increased 25% after one year. I could absorb that once, but got worried about that being the annual norm. I switched insurance companies and then was quoted an even lower price from the first one that jacked up the rates.

I decided I had better find a company I was happy with in case I got sick and was stuck with it, so I switched to Blue Cross. It too has gone up every year over the past 20 years, so I know health insurance was increasing considerably pre-Obama care.

Part of the problem with our health care system is tying it to employers. That ties people into jobs for health insurance reasons. Plus as more people freelance, it doesn't work anyway.

3. What you kind of slide around but don't really touch is that 80% of health care dollars are spent on end of life care. (I'm using that term loosely here.) It's been shown that there are better outcomes with hospice care at end of life at much less cost when compared with hospital care. But discussing this always brings on the screams of "death panels". Given that in my 20s I don't really need insurance why should I pay for it? In my 80s however I'm going to cost far more than my premiums will cover. This is the one thing ObamaCare will help with.

That is part of the issue and end of life care should be discussed. However, you're right, the Republicans started screaming "death panels" and killed the discussion.

4. One thing I always note is that my dog doesn't have health care insurance and he gets better care than I do at a price that doesn't bankrupt me. That includes one very sick dog with cancer that was stabilized for almost a year and that I had to put down a little over a year ago. If the vet can manage it why can't the doctor? The only two reasons I can think of are greed. Greed on the part of the medical community and greed on the part of the malpractice system.

The dog owners I know have been paying outrageous prices for vet care. $200 for a visit. Thousands for bone repairs or cancer treatments. It's not cheap at all around here.

Re: Re: Re: It's what you get when capitalists control a market...

Now you are conflating 'healthcare' with emergency care. Most health care decisions are not life-or-death or emergencies. Yet I know people who run to the emergency room because they get a cold...which in most cases will go away in the same timeline whether or not medical care is administered. For point number 2, that's the beef of the article. Of course, only a few can afford lifesaving treatment...and cost is the question...why does it cost so much?

Re: Re: Re: It's what you get when capitalists control a market...

“Those who believe that the free market can provide healthcare in the modern world are fantasists.”
So you think that Competition, Transparency and removing Monopoly barriers are “fantasy”? Sad world view…

Your 1st point - What? You buy insurance before the time of distress. There are millions of people that buy all types of insurance every day.

Your 2nd point - The point of insurance is to pool to payout on catastrophic events, thus you confirmed my point. The premiums paid by all end up helping payees in the time of need. You can’t prove ”costs need to be spread across lifetime”.

Again, the US system is fixed Against freedom. The McCarran–Ferguson Act exempting Insurance from Anti-competitive practices is, what I think, can be agreed to as “A Bad Idea”. The current system is a mess. As with Govt policies, the unintended consequences of people wanting to do the right thing has doctors quitting in droves and the rest creating a whirlwind of tests and costs.

The best part - if I don’t want to pay the ObamaCare Ins premium, I can pay a tax much lower than the premium and still be fully covered. From the Washington Post - “Roberts (Chief of SCOTUS) noted that a person earning $35,000 a year would pay a $60 monthly tax and someone earning $100,000 would pay $200. But the cost of a qualifying insurance policy is projected to be $400 a month. Clearly, it would be sensible to pay $60 or $200 rather than $400, because if one becomes ill, “guaranteed issue” assures coverage and “community rating” means that one’s illness will not result in higher insurance rates.”
“…Roberts’s decision limits Congress’s latitude by holding that the small size of the penalty is part of the reason it is, for constitutional purposes, a tax. It is not a “financial punishment” because it is not so steep that it effectively prohibits the choice of paying it. And, Roberts noted, “by statute, it can never be more.” …the penalty for refusing to purchase insurance counts as a tax only if it remains so small as to be largely ineffective.”http://articles.washingtonpost.com/2013-01-18/opinions/36475082_1_health-insurance-ac a-premiums

Paying the tax instead of the premium means I’m still covered and can receive treatment because of “guaranteed issue” and “community rating.”

My wife was in a car accident. The 2 mile ride in an ambulance to the hospital: $500. She was in the hospital all of 2 hours before she died from internal bleeding that they did not catch. That cost over $45,000.

Re: There are doctors fighting back.

Re: . . . while independent doctors are closing their shops

"They've found it increasingly unprofitable to practice traditional medicine."

This was a perfectly predictable outcome because of the excessive regulations which make it to hard to comply, and excessively expensive to comply outside huge medical groups. Then of course there is the subject of malpractice insurance, which is much more costly to purchase for a small practitioner.

Re: Re: It's what you get when capitalists control a market...

You think being convinced to carry a tracking device that not only reports your location by collects your demographic information, just because it plays games and allows you to talk to other people, truly a *good* thing? And you don't even truly own it, either.

Re: Re: Re: Re: It's a complex problem

That is true, I also know as a company owner that rates do go up for company plans. Companies often absorb these costs but after the third year in a row of 30% increase I can't eat that anymore. Now my employees aren't happy, but hey my costs have nearly doubled in three years (actually taking all costs into account way more than doubled). These costs need to be passed on or the business will not survive.

Re: So WHO do you finger as the criminal, Mike?

Why would this post be hidden? No obscenity, no personal attacks, no nothing. Just a valid opinion some ideologues don't like. Put the post in the mainstream and ban the "community members" that perpetrated it.

Re: Re:

It's a "cheap shot" (and maybe that isn't the best terminology) on for profit companies because typically these call-outs are being done to shame those receiving the compensation. If you are the head of a privately owned company and you can be profitable and receive an exuberant salary then congratulations to you, you've figured out how to run a business and get rich off of it. If you're the head of a publicly owned company and can be profitable and receive an exuberant salary then you've convinced your shareholders and board that you are worth that excessive compensation, and again, congratulations to you.

While I agree that such salaries may be unjustified and completely excessive, it's not the same thing as claiming to run a charity non-profit while receiving a multimillion dollar salary. When a non-profit finds ways to produce additional income they are completely hypocritical in not taking that additional income and putting to work for their stated mission, whatever that purpose may be. Making the CEO wealthy is a complete contradiction to the purpose of setting up the non-profit in the first place, and it is hypocritical, shameful, and downright wrong.

Again, don't think I support such ridiculous compensation packages, but it just isn't the same thing. Telling someone that they got rich off of successfully running a business is not an insult, it's a success story. Ethical issues and scaling aside, this is the American dream. Getting rich off the back of a charity organization is disgusting and is something you should be punished for, not rewarded.

Re:

The discussion seems to confuse "health care" and "health insurance", and leads to optimize for the wrong result: total individuals covered, not low cost and high quality. Even when regulation permits anything like a free-ish market in insurance policies, that has almost no bearing on cost of care. The typical consumer has health insurance, and the first question asked about a procedure is not "How much does it cost?" but "Is it covered?" The market is distorted.

Re: Re: Re: Re: Re: ObamaCare

"...I don't completely agree with the salary that doctors make but given what goes into becoming a doctor and the life style that it requires I certainly wouldn't deny them a good wage."

Why would a doctors lifestyle be pertinent. Give them a good wage, $250,000-$350,000 or whatever, and limit what they can be paid to do, necessary not elective care. Those that choose to, can take a chance and specialize in elective care, which would be paid for by the elector. Maybe there could be a way where one could do some of both, but I doubt it.

Another issue is to take the burden off of hospitals by opening a whole lot more government run clinics. I have observed some of these in operation, and paid for by the county, and are quite effective. I bet the county doesn't allow for much float in prices, or more directly, the clinics chief who has to maintain the tight budget the county provides. This model is cost effective. Eliminates many emergency room visits. Provides long term treatment for a variety of conditions. We need enough clinics to cover all residents regardless of status, a large portion of them 24/7/366 (don't want them closing on Feb 29. when it shows up.:))

OK, so if you missed it, I am thinking that the Government pays for all necessary health care, but pays the price a single payer can negotiate (say 70% of lowest found retail price) for all goods. Salaries controlled, and supplies controlled. Systems for quality control and expense auditing need to be developed, on the quality side I think there is a lot of history to know what is best, and economically clinic by clinic comparison for cost vs patient (average use of supplies divided by number of patients served compared across all jurisdictions can point out errors early if watched in near real time). Incentives for better medical protocols or cost efficiency would add some color to the process.

Hospitals would then be paid by necessity, and surgeons and specialists might have a different pay scale, rather than annual, hourly. Care must be taken here so that surgeons billing rates don't follow the way of legal billing rates. (I talked for 30 seconds and bill 1 hour).

A mostly single payer system (remember those elective procedures) would take care of the drug price issue to a large extent. Give us our price or we go with alternatives, nationwide.

Speaking of drug companies, just how is it justified that advertising for prescription drugs is allowed to be directed at the end user, when the doctor is the one to make any initial decisions? Do you need the drug? Which one would be better given YOUR history? Any kind of influence at the doctor level should be disallowed as well. The decision should be made upon existing information on the drug. ALL existing information, failed studies included, and of course the patients history.

Next is insurance companies. Insurance is a way of financing some future disaster. You pay the premium, and theoretically you are taken care of at the time of your disaster. Unfortunately there are at least two things that get in the way of this being efficient. Profit, taken every year, even if there is no disaster (and at some point may say 'Hey, we don't have anymore money, too bad), and discount, your property isn't worth what it was when we insured it, and we will only pay X now. The whole point of health care insurance is to pay for the health care, and in doing it this way we add 3 layers of bureaucracy that are entirely unnecessary. The client insurance company relationship. The insurance company provider relationship. And, the insurance company government relationship (medi-anything). What a cost. And it's legislated. The profit of these companies is legislated. Boggles the boggling going on in my mind.

Speaking of insurance, what about malpractice insurance? It seems to me that there is a way of dealing with inept doctors other than insurance. Peer review, patient review, improved negligence legislation in the area, with jail time and loss of license more readily available seem better. Otherwise, we, the end user, keep paying the...Insurance Companies.

I am looking forward to Mike releasing his other articles in this area. What did I miss?

So many discussions we're not having

Ponder this situation. A mother has trouble getting pregnant. Then takes fertility drugs and gives birth to quadruplets. Some of them have are born with health issues. There are significant expenses when they are born and continuing expenses over a lifetime.

Now, insurance companies and the government could refuse to pay for the fertility treatments, so that only wealthy parents can afford those. (Or, even more dicey, these entities might refuse to pay the costs if the parents and doctor decide to let all four babies go to term rather than only allowing one or two babies to go to term.)

But who pays for the childbirth and lifetime health care issues for the children? Can society refuse to pay? Is that fair to the kids?

We've got people not wanting to deny care, but not wanting to pick up the bill either. Some people think charities and non-profits will step in, but will they? And if they won't, are we okay not paying for people who can't afford it? Or will we just pretend that we don't see health care issues for those who can't get it?

Re: Re: Re: Re: It's what you get when capitalists control a market...

I have insurance and was turned away from a walk-in imaging center (needed a prescribed lower back xray) because...I had insurance. Wasn't "capitated" to that place. I offered any form of upfront payment and was still turned away. I could've put a bag of dollar bills on the desk and...nope, limp on out, dummy.

It was right next door to my oncologist's office - part of the same health care system - which takes my insurance no problem.

Insurance, Obamacare, whatever you call it, doesn't fucking matter. Part of the overall problem. Politicizing it is diversionary bullshit.

Dr. Frankenstein and His Collection of Assorted Body Parts.

Suzanne:

Vide Dr. Frankenstein, you can keep a dead body going more or less indefinitely, and run up the bills accordingly. In the case of at least two of my relatives, there were elaborate procedures at a time when there was no possibility of anything that anyone would recognize as a recovery (End-stage Parkinson's disease in one case, climaxing in a broken hip; a mixture of strokes, emphysema, and arthritis in the other). In one case, the attending doctor actual told my father that if he had been present, he would have stopped the revival process. Another relative's demise was remarkable for the number of times he kept pulling his tubes out. I think I'd take that as a fairly clear statement of his wishes. One way or another, you have to set limits on this kind of thing.

The bad news is that it isn't easily available, though your librarian ought to be able to get it for you via inter-library loan, and if you find it at all interesting, you would be well advised to make your own set of copies with a digital camera (*). Knaus went to Russia in the early 1970's, as a "house doctor" for a touring State Department exhibition. One of his people started doing gastro-intestinal bleeding in Irkutsk, Siberia, and Knaus was immediately thrust into the deep end of the Russian medical system. One thing sort of led to another, and he wound up becoming extremely knowledgeable about the Russian medical system, a kind of ad hoc envoy to the Russian medical establishment. So he wrote a book to explain the differences.

One thing you might find interesting is that, in Russia, there is a long-standing tradition of having a lot of women doctors. This produces all kinds of different expectations.

Re: So many discussions we're not having

Pfft, doctors

I'm not buying this idea that the doctors are innocent. They work in these institutions, they profit off of it, some of them work in and for the pharma companies. It is all, from top to bottom and side to side, people who are hiding information on how to make people well and then charging through the nose for the privilege of having treatment for pain or impending death.

I have an insurance plan with a high deductible and the inability of the hospital to tell me how much a procedure will cost is astounding. I spent probably the better half of two days on hold and being transferred around and still walked away with an estimate of $200-$4,000 for a simple procedure that a doctor absolutely did not have to perform.

Re: It's what you get when capitalists control a market...

No, actually that's not true at all. A large part of these issues stem from government policies and the popularity of insurance companies (which have been promoted by government policies). In a free capitalistic market many of these issues would not exist. Obviously there would be draw backs to a system based purely on the capitalistic system, but considering where the system is at today I would think a shift to less regulation is what is needed.

No transparency

Neither your insurance company nor your doctor will tell you jack diddly about what processes they use to decide whether or not you will suffer, live, or die. All these patients bills of rights - they just ignore.

Don't even think about any "rights" in the VA, and heaven help everyone when the Patient Protection and Affordable Health Care Act fully takes hold.

We all know advertisers are a creepy corrupt bunch of liars

someone I knew from a few years ago worked for an advertising company as head of technical research. He was so sick of the lies and corruption found that he finally left and pursued a career in the medical tech industry.

After some 12 to 18 months, he left this and went back to his old post in the advertising company.

When he got back, he was asked whey he came back when the advertising business is so corrupt? His response was that those in advertising knew nothing about corruption or lying, they were likened to innocent babes in mothers arms.

Having heard some of his stories, I don't wonder at any of the charges and prices I hear about for any hospital services etc.

Years ago, my wife had to have a special scan. I went with and saw the equipment being used. Just out of interest, I asked how old the machine was and how much was the price of the computer hardware being used.

I was told the machine was less than 6 months old. The computer being used to control the system had cost on the order of $50-$60 thousand dollars. I was shocked. I hadn't seen a computer of its ilk for at least 10 years. We had used those same machines at least that long ago. It was brand new but ancient in technology (as tech goes).

Re: Re: It's what you get when capitalists control a market...

"It would seem like a combination of government laws and regulations that prevent new competition in the market."

I agree and I think this is the core of the issue here. What we're seeing here is not capitalism, what we are seeing here is the result of anti-competitive laws. Just like with all other markets in the U.S.

Re: Re: It's what you get when capitalists control a market...

I'm all about free markets, but "capitalism" presumes capital, itself a construct of governments and corporate entities pretty much from its inception in northern Italy.

Capitalism and Socialism are the same thing, basically. The real problem right now is largely "centralism", but ultimately things break down into good, old fashioned greed on the one hand and apathy on the other.

Re:

This article forgets to mention the many volunteers that freely work/volunteer for hospitals and the free labor that goes into that and how this free labor may benefit those getting paid. Not that there is anything wrong with volunteering.

Re:

Over the years and taking care of family through medical emergencies and death I have had numerous dealings with the medical industry both wonderful and disgusting. Find a trusted doctor and stick with him/her. I hope this essay is solution oriented and helpful. I don't think the health-care problem is complicated just corrupt.

Medical practitioners are the biggest professional liars I have ever, ever met. Not having insurance there have been several times of when the medical firms people (nurses, doctors, receptionists) have told me that there would be no or a low charge (because I was going to walk out) for an emergency service. The bill was in the mail every time. Same for nursing homes and have similar experience from them lying to me about room charges (to get us to stay for a while longer) and worse because they are almost like prisons where getting out is just like an thrilling escape. The bill was in the mail almost before we got back home. They are outright liars of the worst professional kind and the sales speech the spout before you enter is almost a meaningless thing. To hear this story about chargemaster fees is no surprise.

Medical tourism is becoming extremely popular in the US and getting sick in the US is starting to become a nightmare. Taking a trip to Mexico or some small Caribbean or South America country for a large dental, or medical surgery is now a normal thing. Getting prescriptions from Canada is a classic way to save huge money.

I do think that a (truly) free market is still the best way and that the real problem (for the most part) is that legislation has been abused to un-free the market. Basically, corruption. Only some tweaking on the free market model is needed. The real problem is runaway government.

I would support legislation that forced (I'm not asking) that the chargemaster fees to be the actual price for individuals, insurance companies and Medicare, etc. alike. Since the large firms and government agencies would quickly force the chargemaster fees to be as low as possible it would then repreesent the cost of hospitals real ROI and margin of profit. This is the only legislation I think is needed. (in combination with removing other legislation)

While I'm at it... beyond having a degree a specific area of medical practice you are practicing I would also like to see the current licensing scheme thrown out. (throw out the BARR association admittance requirement too while we are at it) There will be no limits on malpractice lawsuits whatsoever of course.

“Any business, firm or organization may open and do business without forced to join any organization, club or party.” or something like that.

To keep drug prices low we will be eliminating all laws about drugs both prescriptions and illegal ones and closing the DEA completely. This will allow the purchase of medicine from any country or lowest price vendor. The FDA would still be required to sample and close down providers of low or no quality drug-makers. Closing the DEA will profit in many way including not destroying peoples lives and making them economic drains on the economy.

To solve some of the privacy issues with current health-care providers it will be allowed to sign in with the name “John Doe” if you are paying cash. You keep your own medical records.

On a different track: As for the chargemaster fees being discounted to some wouldn't the IRS consider the discount as income and be taxed accordingly?

I seem to be last to post (and wonder if anyone will read this) but I really think the comments everyone made were constructive and made this post much better. Thanks.

It's mostly a non-free market

If people were able to go to the doctor across the street or down the hall and get a better price it would be closer to a free market. This doesn't happen due to more paper work than time with patients because of regulations and fear of litigation and the American Medical Association putting a limit on MDs that drastically lowers the number of doctors. There are also limits on competition across state lines, this is a direct block on free trade.

Over half of the healthcare industry is government funded and this gives an incentive for higher prices. The government has lots of money, people want healthcare, and politicians want to be the ones to give it to them at any cost. Notice how the exact same thing is happening with college prices as government pays more of the bills and gets more involved, this is no coincidence.

This doesn't happen with a reputable Vet or Dentist. I had a full jaw x-ray and was put under for oral surgery to have a deep wisdom tooth cut out and then needed stitches. I paid just over $1000 and this included many check-ups afterward, a plastic squirt tube and keep it clean, and a zip-lock bag full of gauze pads. This is still not a fully free market but it's much better because it doesn't have many of the same market manipulations.

Re: Re: Re: Re: Re: Re: ObamaCare

I strongly disagree, though I largely understand your reasoning as to why doctors shouldn't "profit off of sick people". I believe that it should be within their capacity to make a profit, but I also agree that insurance companies should be able to make more than a 2% margin, on the proviso that a good percentage of that amount goes back into assisting uninsured people, at least in the US.

Re: Re: So many discussions we're not having

There was a time before insurance and all this "healthcare" stuff. Gee, how did mankind ever survive?

Actually a lot of them didn't. Women died in childbirth. People died from infectious diseases. Families had lots of kids because a good percentage of those kids didn't survive into adulthood.

The diseases that kill people in the US now (e.g., cancer, heart disease) are diseases that people get if they live long enough. We've eliminated lots of stuff, but now we are dealing with diseases/illnesses that kill people when they are older.

Re: Re: It's what you get when capitalists control a market...

In a free capitalistic market many of these issues would not exist. Obviously there would be draw backs to a system based purely on the capitalistic system, but considering where the system is at today I would think a shift to less regulation is what is needed.

Can you cite a medical system anywhere in the world that operates on a purely capitalistic system where everyone in that society gets affordable health care?

I'm open to anything that brings down the cost of medical care, but I don't think the system you describe exists. There are societies where there is no government health care and no regulation, but treatment is not available to everyone, either.

I'm not sure you can have a truly unregulated health care system where there is no drug testing and no training requirements for health care professionals and expect people to be cared for safely.

Here's one example. What about blood testing for HIV and hepatitis C? Let's say you've had an accident and need a transfusion. How do you know that the blood you have been given is safe? Sure, you can sue if you have been given unsafe blood, but by then you have the disease.

WRONG!

"THANK YOU!!! Every healthcare "debate" ignores this question."

None of the debates ignore this question. The question is simply not relevant. If you are trying to prevent reformation of a corrupt system, then you have to IGNORE as many facts and as much evidence as possible and stick to rhetoric that will inflame the masses against their own betterment.

Keywords:
Economic disaster
For the Children
Socialist
Communist
Job creation
Wealth redistribution
Job losses
inferior medical care
Death camps
the terrorist will win
national debt (NEVER include debt of the ill person)

Re: Re:

I don't have links to hand, but I've read stories about people waiting 2 hours for an ambulance, people dying on gurneys, people literally being turfed out onto the street to die because they couldn't pay for essential non-emergency care. Anecdotal data is anecdotal. Not to mention the medical bankruptcies and other problems people in the UK (and the rest of the civilised world) never have to think about.

If you think that a few cherry picked headlines from the anti-NHS Torygraph is proof of anything, you're a blithering idiot.

Re: Re: It's what you get when capitalists control a market...

Unless you consider that health care demand is fairly inflexible, and any new hospital opening knows that. They have no reason to cut their costs in half to "compete". People will utilize the services regardless of the price, when the alternative is their dwindling health or possible death. And of course the hospitals would rather make 500 million in profit rather than a mere 250 million…

Re: Re: It's what you get when capitalists control a market...

Unless you consider that health care demand is fairly inflexible, and any new hospital opening knows that. They have no reason to cut their costs in half to "compete". People will utilize the services regardless of the price, when the alternative is their dwindling health or possible death. And of course the hospitals would rather make 500 million in profit rather than a mere 250 million…

Re: Re: Re:

I never drew such a broad conclusion; you came to that on your own. I outlined causes+effects that are causing real-life grief.
I didn't cherry-pick those C+E to force an inaccurate conclusion either. If I had, it could be easily disproved by adding whatever info I omitted.

Here's a restatement of my point.

1) The US Gov is by far the single biggest financial player in the US healthcare system.

2) Stipulations for reimbursement by the US Gov are onerously complex. This problem is at least a generation old and it continues to worsen.

3a) Complex regulations almost always favor larger players who can more easily dedicate resources needed to cope with them.

3b)US medical corporations have every motivation to lobby US legislators to structure Gov regulations to favor their industry. US legislators will continue to to respond favorably to industry lobbying.

If you put on me to draw a conclusion, it would be this.

Neither the US Gov nor US corporations posses sufficient ethical responsibility to be entrusted with our healthcare.

Re: Re: Re: Re: It's what you get when *CRONY*-capitalists control a market...

Do you seriously think those things should be subjected to a competing market? I can guarantee disaster.

Also, who's preventing companies from competing in healthcare? That particular strawman is the fantasy of morons. Most people in countries with socialised healthcare can choose private care if they wish and can afford it. They just can't avoid paying their fair share of the basics (which are still there for them if the private solutions fail.

Not a free market? No, Duh!

Of course health care is not provided by a free market. It is provided by a collection of state-granted monopolies. The latest medical advances (both drugs and medical devices) are all sold under government granted monopolies called "patents". Physicians collectively function like a medieval guild-monopoly -- the state licenses those who can practice medicine (yes, arguably for good reason, though there are places around the margins like delivering healthy babies and a good deal of primary care that can be provided equally well by non-M.D.'s but most of the several states shield physicians from competition) and the profession constricts the supply to keep rates up. In many places a local hospital has a genuine monopoly on providing many forms of health care, as there are no other facilities capable of doing the same for hundreds of miles around.

Even where hospitals in theory should compete, they do not, because third-party payment for most medical services prevents an effective market from developing (and the services are being provided as a front for the guild-monopoly of physicians and the monopolies of medical and pharmaceutical manufacturers).

And all of these monopolies, unlike utility monopolies, have their rates unregulated.

Don't look for anything to fix this. Just as in copyright and general patent matters all of us who read TechDirt are familiar with, the incumbents in the market like things just the way they are, have a lot of political clout, and now, rhetorical cover from the phrase "health care" having been turned into a Newspeak phrase that means any of "health care", "health insurance", "government-run/regulated health insurance", or probably one or two other things according to what the Party needs it to mean at any given moment.

Whatever you think of the Obama/Pelosi reform of health insurance, it didn't do anything to reform health care. What's needed is the recognition that health care is provided by state-granted monopolies and the will to regulate those monopolies as to rates charged.

Re: Not a free market? No, Duh!

In many places a local hospital has a genuine monopoly on providing many forms of health care, as there are no other facilities capable of doing the same for hundreds of miles around.

Actually, in many areas there are more hospitals than are needed. Same goes with equipment like scanners. Lots of hospitals get them and then prescribe unnecessary tests in order to pay for the equipment. One problem is that consumers aren't able to tell when they need tests or have been sold on the idea that they need them.

Now I suppose if hospitals will only treat people who can pay, that would discourage unnecessary treatment of the poor, and that is one way for the market to work. But then we have to face up to the idea that health care varies according to income and savings.

Address this: Heaviest users usually least able to pay

How would all of you structure a system to accommodate the small group of heavy health care users who often have no money to pay for that health care?

Driving down the price for them helps, but they still don't have any money and probably aren't earning any if they are very ill, disabled, very young, very old, etc.

How should society address the healthcare needs of those who have the highest needs and the fewest resources? It's not a group a for-profit company is likely to serve unless someone is picking up the tab. There's no money to be made to provide services for free.

Re: So WHO do you finger as the criminal, Mike?

I'm a home hemodialysis patient. I do my own treatments from putting in the needles, to monitoring the equipment, to washing everything down after I'm done. I am charged $580 per treatment for this privilege. There is no visiting nurse or healthcare attendant, and my monthly visits to the doctor in clinic are charge separately. Yet somehow you take all of the information put forth in this piece and try to slam Mike for talking about it? What the FUCK is wrong with you?!?

Re: Re: Re: Re: Re: It's what you get when capitalists control a market...

Actually they aren't, uninformed boy. If you think that urgent care is the core of healthcare, you've got a very twisted view. Counseling, diet consults, regular check-ups, even the occasional stitches and illness. None of these are 'life and death emergencies,' yet they are the beef of most peoples' health care decisions.

My experience with Mercy Hospital in Springfield

I was in a wreck July of 2011, I was a little sore, but the ambulance driver kept telling my I might have internal injuries so I agreed to take the ambulance 2 blocks to the hospital.

I get there and they rush me straight back to do a ct scan, and an xray. I tell them I am okay and don't want all of these tests, but they tell me they need to do them anyway.

I was in the hospital about an hour and a half

Well as I knew, I was just fine, until two weeks later when the bills started arriving. I was expecting a couple thousand dollars, but my bill was 11,300 for the hospital and 1800 for the ambulance. My car insurance covered $1000.00

Re: The article doesn't take it far enough.

"Can anyone tell me what the result of an industry collapsing the accounts for 25% of our GDP?"

A collapse of the economy, followed by civil war and tyranny, followed by the rise of a new system and possibly a new political order which will hopefully be more sane and just that the current one. It might not be, thought. When economies fail, empires die and dark ages begin.

Re: Re: Re: Re: Re: Re: It's what you get when capitalists control a market...

Measure by cost and impact on your life and you will find a very different picture.

The odds are quite high that somewhere between the ages of 50 and 80 you will encounter a life threatening condition that is beyond your ability to pay at the time (unless you are in the 0.1%). That is what we are discussing here.

The fact that you also have a lot of minor ailments through your life and buy some vitamins and painkillers is totally irrelevant.

Under your proposed system I am already dead (twice). Fortunately I live in the UK and remain healthy both physically and financially.

Re: Re: ObamaCare

High salaries?....irc162m...requires an insurance company to pay the personal income tax bill for any salary(including stock, stock options, bonus etc) over 500k, in addition to the employee paying the income tax as well. What kind of talent can you recruit with these rules in place?

MLR says an insurance company has to spend 85% on claims or refund the difference.

Hospitals cost shift because of non payers, which drives costs higher for payers. The amazon examples are moot...if amazon could only collect from 7 of 12 buyers, the prices quoted would increase substantially.

Re: Re: It's what you get when capitalists control a market...

From a European perspective, most of us have some form of government-regulated healthcare system. We have equivalent success rates to the US, but our treatment costs a fraction of the price.

I'm from England, but lived in the US for 5+ years. I have experienced of healthcare on both sides of the Atlantic, and found the quality of hospital care to be similar in both countries. The major difference was the cost.

Our healthcare system is open to everyone, and is free at the point of use. To fund this system, we pay 9% of our income in National Insurance (on top of 22% income tax). This covers our healthcare and state pension.

Re: Re: It's what you get when capitalists control a market...

The thing is, we want there to be certain barriers to entry; individuals generally don't have the resources to evaluate a doctor's care against current standards. Some industries function fairly well without consumer safeguards, but intensely local industries with low consumer knowledge and inelastic demand don't self-regulate well.

Re: Re: Re: ObamaCare

Hospitals cost shift because of non payers, which drives costs higher for payers.

Yes, that is a big issue that needs to be discussed. Rates were going up for those with money in order to subsidize those without. But then, as insurance rates go up, more people and employers drop out, which reduces the pool even more, thus driving the rates up even more.

The way health care has been working pre-Obamacare was going to go under anyway.

Re: Re: Re: It's what you get when capitalists control a market...

I'm from England, but lived in the US for 5+ years. I have experienced of healthcare on both sides of the Atlantic, and found the quality of hospital care to be similar in both countries. The major difference was the cost.

Canadians have also said that given a choice between their system and the US, they will stick with theirs.

And I have an American friend who lived in New Zealand for seven years and even though she is now back in the US, she still flies to New Zealand for medical checkups/treatment because it's covered there for her, and not here. (And her ex-husband was a US doctor.)

I grew up in a US military family and our health care was covered. It was great. That was one less worry. And I liked the fact that you didn't get unnecessary treatment. I avoided treatments that were in vogue when I was a kid that now have been proven to have been harmful. I got what I needed, but nothing more, which is how I prefer my health care.

Re: Re: Re: So many discussions we're not having

Re: Re: Re: Re: So many discussions we're not having

And yet the human race has managed to survive, reproduce, and thrive.

And we can certainly go back to the days of no health insurance and more limited medical care if that is what you are suggesting.

We're all going to die, too, and no one has yet figured out how to stop that. But most people opt for techniques that prolong their lives and give them improved quality of life. But for the survival of the human race, I suppose that isn't necessary. Have your kids, live long enough to raise them, and then you can die having accomplished one of your main purposes in life.

Re: Re:

That is not a problem at all, just a bump on the road.
When you have the knowledge you don't need to follow those rules, just be aware of them.

What can't go on is people leaving their health in the hands of people who don't care.

Start small, learn how to do check ups by your own self, learn to build some simple instruments(i.e. microscope, centrifuge, ECG) start learning about medicines, you can manufacture blood thiners(aka Aspirin), start forming groups, start accumulating the knowledge, every little bit you learn is a bit you don't leave at the hands of uncaring people.

Build the fucking foundations of a system that your sons and daughters will be able to use and expand, DO NOT FUCKING LEAVE THIS TO GOVERNMENTS OR COMPANIES.

Re: Re: Re: Re: So many discussions we're not having

What is more in most developed countries we also managed to work out a way of paying for it that didn't bankrupt the sick or leave a large proportion of the population without adequate cover.

Then there is America - which has been moving steadily backwards on that front for the last 50 years because of its irrational phobia of anything that can be labelled socialism. Your solution of going all the way back to the dark ages is, I suppose, consistent!

Re: Re: Re: Re: It's what you get when capitalists control a market...

The deaths of hundreds of hospital patients, left without food or water in filthy conditions, exposed an urgent need to change the culture of Britain's National Health Service (NHS)
Local problems in one particular area probably caused by political meddling driven in part by US health companies trying to muscle in - and NO ONE in the UK is calling for a radical change to the system - we will fix the problems in our own way.

Most of the people mentioned in this report would not even get to a hospital in the US - they would have run out of money and or insurability long before and would be dying at home.

Re: Re: Re: Re: Re: So many discussions we're not having

Insurance is not a real problem, because all they do is manage the risks and collect money, people can do that too, but instead of paying an insurance company you pay directly for your community clinic that receives that money directly.

Why do you need others to administer money for you?
Why do people keep handing control over their finances and health to people who don't care?

Re: Re: It's what you get when capitalists control a market...

Central planning never works because No One can anticipate what will really happen.

Actually central planning works fine when the planners get good information fed back from the grassroots and badly when they believe they are the fount of all wisdom.

If central planning doesn't work how come the US has successful mega corporations like Google, Apple, Microsoft etc. These organisations all run central planning internally. By your thesis they can't exist - but they do!

Re: Someone?

It is a disaster, but if you look at the math of the situation described in the article, they said the hospital had $198 million dollars profit on 2.586 billion in revenue. This means the hospital made 7.6% profit. This seems reasonable actually. Banks make a 12.6% profit. Railroads make over 12% profit. The real estate business makes 10% profit. Life Insurance has an 11% profit.

So, if the profit is only 7.6%, what's really going on? If you reduced the prices of EVERYTHING (all products and services) at the hospital by 7.7%, the hospital would be losing money, and all those things would still be outrageously priced. The answer is...it's broken somewhere else.

Another scenario

Let's say someone gets hit by a truck. And has no health insurance.

Should the hospital take him in and treat him? Should the government have a pool of funds to cover that?

If there are no government or charitable funds, should the hospital charge higher rates for everyone else to generate a pool of money to pay the uninsured? Or if it doesn't do that, should the hospital workers work for free to treat everyone who needs emergency health care but can't pay for it?

People aren't talking about stuff like this. Do we let die people who can't pay for health care? And if not, who pays for it? Even if we drive down health care costs, how do we pay for those who can't pay?

This is a societal question. How do we deal with those who have needs but no money and no ability to earn enough to repay the debt? Those questions must factor into health care discussions. We can refuse to treat people without funds, but that will be a reflection upon our collective values. If this is what we choose to do, then we might as well be upfront about it.

Re: Re: It's what you get when capitalists control a market...

I understand this common fallacy. We assume the free market works. 2 core assumptions underly ALL free market theory: everyone has perfect information, and everyone is rational. Neither of these are true.

In healthcare, neither are true in the extreme. Just as the article says, the patient has basically no ability to make a rational decision (pay a reasonable amount for a reasonable return), and the outcomes of particular paths of care are highly unpredictable. There's nothing about healthcare that leads me to believe that a completely free market would work out better than the current system.

Better regulation is really the only feasible way to I see to solve this problem. Its not like regulation is inherently bad. (Adam Smith assumed at least a minimum level of regulation was in place: laws protecting property-> no serious economist would argue to deregulate the "theft" market). The question is degree. Here, we obviously have not regulated the healthcare industry nearly well enough.

While I agree with the pints made in the article, my two most recent experiences with healthcare are slightly different. On one occasion I had insurance and broke my arm in a bike accident. I paid somewhere around $800 out of pocket on around $8000 worth of bills. I consider that not too bad.

Then I went into the hospital a few years later for something I can't go into, but I was unemployed at the time and the bill was around $80,000 and a hospital charity covered my entire bill. kookie. I know this is not the norm and the system is fucked and I consider myself lucky. just wanted to share my experience.

Re: Re: Re: Re: Re: So many discussions we're not having

Re: Re: Re: Re: Re: Re: So many discussions we're not having

What will you do in a post-apocalyptic world?

People would be looking at an entirely different set of priorities. And if we want to talk about that now, there is a whole lot of other stuff to put into the discussion in addition to health care as we know it today. Much of modern life is pretty expendable when we are talking about basic survival. Get rid of the multiple cars, the McMansions, the stock portfolios, the energy intensive tech devices, shipping food across the world, and so on.

If you want to ponder doomsday scenarios, we can always start with climate change.

Re: Repay in small amounts

That only works if you have no assets and make little money, so as usual the middle working class is screwed....you own a house and make say fifty thousand a year...court will likely force you to pay more....of the inflated bullshit medical costs....

Re: There are doctors fighting back.

Yeah...fighting back by charging more than the procedure is billed at under insurance. Seriously, this guy's prices are $300-4000 more than they would cost out of pocket if your insurance denied you a claim.

Re: Re: Re: Re: ObamaCare

Correct, you drop coverage because increasing premiums become unaffordable. Premiums continue to rise because cost of care continue to rise, due to cost shifting. It's a death spiral. What do think will happen when the market is equalized 2014, and it costs a family 15k year to have coverage? Penalties are waived if bronze is 8% of income. There is no incentive to buy coverage. 3 weeks ago IRS estimated bronze(cheapest) to cost 20k in 2016, before taxes. Sounds like a lot more uninsured to me....which means more cost shifting, and higher prices for care....and round and round we go.

The subsidy is a scam. You pay income tax on the premiums paid, and the govt gives some back and calls it a subsidy. You need to earn 23000 to have enough left over to pay a 15000 premium(25fed,7.65fica,5state). How does an 8000 subsidy sound now? It's your damn money they are giving you.

Health care and health insurance are 2 different things. People are in for a big surprise when they figure out how much 'free' insurance really costs.

Re: Re: profit of 7%

Profit is irrelevant. What is relevant is return on investment. If the owners of the hospital put up $1 million originally and are now pulling 200 mil a year in profit, that's pretty good. 200 mil a year implies an investment of 4 billion dollars in today's market, and I don't think you'd find that a single hospital put up that kind of number to get going.

Re: Re: Re: Re: Re: ObamaCare

Obama essentially adopted a Republican proposal to save health care.

Individual health care insurance mandate has roots two decades long | Fox News: "The mandate, requiring every American to purchase health insurance, appeared in a 1989 published proposal by Stuart M. Butler of the conservative Heritage Foundation called 'Assuring Affordable Health Care for All Americans,' which included a provision to 'mandate all households to obtain adequate insurance.'"

I would have tackled health care cost first, and then worried about extending coverage to everyone. So rather than the insurance mandate, I would have looked for some smaller scale experiments within states or organizations that have been successful at lowering costs and then would have pushed to expand those.

And those to the left of Obama fault Obamacare for not being a single-payer/universal healthcare system. That would have been my preference. As I said, that's what I grew up with and I like it.

I think it is a given that health care costs are too high and unaffordable for many. I think the government is going to have to use its clout to get lower prices and when that doesn't happen, I think restrictions on what services are covered will likely have to happen (that doesn't mean people with money can't buy more coverage, but the basic coverage will likely be more bare bones). Doctors, hospitals, and drug companies may have to accept that they will be getting less money. And I certainly hope insurance companies get less.

As I said in a previous comment, the healthcare situation is complex and requires changes up and down the system, including how people take care of themselves. As a country I hope we start living healthier lives and need less care.

Re: Re: Re: Re: It's what you get when capitalists control a market...

Once agains you quote a few sensationalist newspaper reports that exaggerate the scale and reach of a few local problems.

The fact is that the US has been trying to have a private "capitalist" system for years and it has worked worse and worse over time. As a consequence there have been numerous attempts to fix the system whilst not really changing it (as you list them yourself) and every time it has failed and made things worse.

No country in the world successfully implements the system you propose whereas there are many reasonably successful variants of the system in the UK.

The system in the UK is also extremely popular with the public. That is not an accident it is because by and large the system works and we don't have to worry about health costs at a personal level.

If the isolated events you quote were widespread then the public would not be so supportive of the system.

The real problem in the US is that most people's healthcare used to be handled through their employer and most people expected to work in the same job throughout their lives. That has gone and will not come back - hence your present predicament.

Universal coverage is a good step towards managing the inflated charge master. Only the uninsured get hit by these outrages prices. The insured, not so much. The thing about those prices, say 3 dollars for a gauss strip versus 3 dollars for a box on amazon is that one is for an emergency setting and the other is not. Yes, if you have a minor wound you can care for yourself, but if ou need medical attention, the doctors expertise costs money. You cannot judge hospital prices against the market because when your life is on the line how much more valuable is each piece of equipment to you? Common sense would say it is invaluable if it saves your life. For he most part the economic forces do not play in the hospital charge,aster because the majority of ppl have insurance. Insurance reimbursement is wher the price war is and as some people said a little visibility may go a long way. The uninsured are left with a hospital monopoly, not a free market. Universal coverage

Re:

Only the uninsured get hit by these outrages prices. The insured, not so much.

That's a big problem. Even if you want to price shop, you can't because it's hard to find out the actual price. You get a bill from your insurance company and it quotes a price that that isn't the price the insurance company actually pays. And a lot of medical places can't give you a price if you pay cash at that moment because they don't have it.

For medical services that insurance companies don't cover (e.g., cosmetic surgery) there is competitive pricing, but quality can vary greatly among providers. And among those there are providers who don't use anything close to safe procedures and people have died in backroom offices as a result. Unsanitary conditions, contaminated drugs, lack of emergency equipment.

The reason we have as many regulations as we have is that in the past we had a lot of unregulated health care that killed people. Unsafe, unmonitored medicine. Untrained practitioners. Quacks. I'm not defending over-regulation, but generally there is a reason we've ended up with each regulation.

This is a message for anyone outside the US in a country that has a Universal Health Cart system:

The article above pertains to the processes of Obamacare....which forces US tax payers to pay for the revenue stream supposedly gained by this. The GOP of the US Senate actually filibustered to NOT raise the debt ceiling, which is by all means a historical event in the entirety of the US Politics.

Congress created the debt ceiling as a means of control to make a president look bad if they do not agree. The practice has been around since the days of Herbert Hoover. The president of the United States has no control over the Debt Ceiling and can only propose budgets and raises of that nature.

Historically speaking, President Barrack Obama is the first president to push for spending by actually demand increasing the Debt Ceiling in the US.

Obamacare was originally only going to add prescription benefits/coverage and disabilities care, and to prevent Medicare and Medicaid fraud in hospital bills. That was tax affordable, but now you pay the tax if you cannot afford health insurance. The US government becomes an insurance broker in 2014....and it is not economically sound.

Re: Re:

I've gone through experience of shopping for a dentist for basic case. I don't bother with dental insurance because I found it didn't cover that much.

So I go through the ratings and friend recommendations and "best dentist" lists to find someone who is (1) reasonably priced, (2) competent, and (3) honest (won't try to sell me services I don't need). It's been hard to identify dentists who are all three. And if you do go to a dentist and he tells you that you need a lot of services, how do you know? Do you trust him or seek a second opinion? It's like shopping for an auto mechanic. Once you've found someone who is reasonable, competent, and trustworthy, you stick with him, but you are likely to have had some bad experiences before you find the right one. It's bad enough paying for mistakes with a car. It's worse when it is your own body and the bills are likely to be higher.

Re: Re: So many discussions we're not having

Re: Re: Re:

When am I going to learn not to discuss health care on the internet?

No, I wasn't suggesting we do away with regulations like the one that requires medical licenses. And yes, as I said, the high cost of education is part of the problem. (And note that when you start a question with "don't you think...", it suggests to me that you're not really interested in the answer.)

2) No, I wasn't suggesting that we do away with liability litigation. Any maybe market forces can do a better job, we should certainly consider it.

Also, it would be great if juries were more aware of the consequences of huge awards. And before you ask, no, I'm not suggesting that we do away with juries.

Re: Re: Repay in small amounts

If people can't be denied life saving care then the basic problem of dealing with BASIC medical needs solves itself. The system absorbs the costs without any need for government meddling like Obamacare or socialized medicine.

Unfortunately bankruptcy law was meddled with as a gift to banks. Otherwise the financial end would be completely transparent to the "poor consumer".

Brill on health care: Steven Brill's opus on hospital prices.: "I can see two reasonable policy conclusions to draw from this, neither of which Brill embraces. One is that Medicare should cover everyone, just as Canadian Medicare does. Taxes would be higher, but overall health care spending would be much lower since universal Medicare could push the unit cost of services way down. The other would be to adopt all-payer rate setting rules—aka price controls—keeping the insurance market largely private, but simply pushing the prices down. Most European countries aren't single-payer, but do use price controls. Even Singapore, which is often touted by U.S. conservatives as a market-oriented forced-savings alternative to a universal health insurance system, relies heavily on price controls to keep costs down."

Re: ObamaCare

NPR had a nice article on breast pumps. Due to Obamacare, they are now apparently a mandated to be covered under health insurance. I suppose the idea was to encourage mother's to breast feed.

Whether or not this is good public policy is another thing.

Regardless, as soon as this went it effect individuals immediately started to game the system. Mass corruption on an individual scale began. As soon as people realized that there was a big give away, people started acting like it was a cheap Vegas buffet. People ordered pumps they didn't need and the most expensive ones they could find.

One little part of Obamacare was abused the moment it went into effect. People even got extra pumps even if they didn't need one because they already had one.

They just got them because they could like some sort of scavenger on one of those Hoarding reality shows.

THAT is the problem with offering something for free. The American consumer just can't handle it. They will abuse it. They will game the rules for no clear personal advantage. Then genuine thieves will start.

Tell Americans something is free and you will gaurantee that it it costs at least twice as much as it needs to.

Shame implies guilt.

No enterprise should be ashamed to publish it's executive salaries. It's a classic case of "what have you got to hide". Perhaps we aren't all as enamored by Ayn Rand and Gordon Gecko as we would like to think. There is some sense of shame there driven by a sense of fairness that isn't entirely MIA after all.

Re: Another scenario

> Let's say someone gets hit by a truck. And has no health insurance.

Then they are very stupid.

Medical riders on car insurance are dirt cheap and allow you to have full control of your treatment. Insurance agents don't like to talk about them because they aren't a money maker. However, they are very effective.

Re: Re: ObamaCare

THAT is the problem with offering something for free. The American consumer just can't handle it. They will abuse it. They will game the rules for no clear personal advantage. Then genuine thieves will start.

I fully support putting limits on how much is covered by health care. When people have unlimited coverage and no deductibles or co-pays they might get more health care coverage than they actually need, simply because it is free to them. "Massages are covered? Sure, I'll have one every week."

I support breast feeding, but I agree that there's no reason insurance should cover expensive models. In fact, I'd order a bulk of the basic model and tell mothers they can have that for free (with a deposit that can be refunded when they return the pump) or they can pay the extra themselves for something more expensive.

Re: Re: Another scenario

Then they are very stupid.

Medical riders on car insurance are dirt cheap and allow you to have full control of your treatment. Insurance agents don't like to talk about them because they aren't a money maker. However, they are very effective.

I was thinking about a pedestrian. Now I suppose that person could sue the driver, but perhaps the driver is driving without insurance, too. It's been known to happen. Some people drive with suspended licenses, so they probably aren't bothering have mandated car insurance.

Re: Re: Re: why are the prices absolutely insane.

Suzanne I am really glad you asked for the specifics. No most people won't see it, but.....

*grabs Calculator* Divide that $18,000 by about 370,000,000 then divide the result by 30% (0.00004865 divided by .30)and multiply that number (0.00016216) by 370.000,000 *puts calculator*

...the US Federal Government would have spent roughly $60,000 dollars on that procedure under Obamacre if your medical issues had occurred when it was active. That funding could go elsewhere like employment funding. So while the procedure cost you co-pay under normal health insurance policies and laws here before Obamacare set in...If it were set in after Obamacare and you didn't have to pay....that is how much Uncle Sam spends on each person.

*grabs calculator again* 370,000,000 tax payers (estimated by the time Obamacare rolls around in 2014, everyone will be paying the same amount at 30%, business ownerships or not) times $60,000 dollars per person Obamacare pays for....

that is $22,200,000,000.......which happens to be the current Debt Ceiling. At any time we spend more that that value based on the current economic stream....will cause the value of the US Dollar to default and become negative. We would go into bankrupt as Greece and Iceland had done.

Re: It's not just the hospitals and med providers

I know firsthand that the insurance industry is a large part of the 'problem', as defined in this article. It ALL boils down to G R E E D. Even the lowest paid insurance CEO makes more than $1,000,000 a year. To me, NOBODY is worth that.
It isn't a 'capitalism' thing, it's fascism.

Re: Re: Re: It's what you get when capitalists control a market...

Once corporates control government their involvement ensures the government skews the market in their favour. Regulatory Capture
Without government exerting any control, corporates don't need to go through the step of exercising power over government and skew the market directly. Monopolies and Cartels
Only with government exerting control and skewing the market in favour of the citizenry does an outcome beneficial to the majority occur.

Amazing that laissez faire is so in vogue, laissez faire happened, it was horrible for the vast majority and we changed it because of that.
It was marked by squalor,poverty, disease and a low value on life.
What is truly bizarre is that the same people who want totally free markets where the conditions cannot possibly exist for them to work properly (the real world) because distance is real, access is uneven, choice is limited and people are not wholly rational creatures
go completely against free markets in the one place that comes closest to meeting the criteria for a free market to function - online, where distance is irrelevant, information is available to everyone equally but the people there are of course no more and quite possible less, rational.

Re: Re: Re: Re: Re: why are the prices absolutely insane.

I agree that they won't see it in taxable income...the increases isn't even a part of the income tax. The 30% us from what you net after taxes.

The is fact that your procedure under normal US health insurance (non-Obamacare)would have cost you roughly $18,000....under Obamacare, the federal government pays $60,000 for that same procedure.

Individuals will not see an increase personally on tehir own until they hear more about how it has an effect on the economy in 2016...by then it would be too late for the US to get out of debt. I cannot predict that but I can tell you one thing...It will cost the US GOVERNMENT 30% more to pay for what you would normally have to if you were insured outside of Obmamcare.

Re: Re: Re: Re: Re: Re: Re: why are the prices absolutely insane.

Unfortunately for those of us in the United States, The US Supreme Court already approved Obamacare....we are stuck with it, and it is in no way universal health care like other countries. Sorry for the caps :-) The United States GVT. becomes the insurance broker who spends more money than it really has to pay, the 30% tax actually generates negative revenue we only get a choice to change the Presidency every four years and Congress every two. We are stuck with it. I would prefer the UK'a system over anywhere else.

US vs The World.

I have a message for anyone outside the US:

Most of you have universal healthcare. That's fine and dandy :-) I commend you for it. The problem here in the states is that unlike other nations with universal health care, ours under Obamacare is Universal Health Insurance.

That's when regulation is needed. When the system is abused you need to put limitations to avoid or reduce such abuses. The US Govt is not interested in limiting any abuse however. Which is unfortunate.

Re: Re: Re: It's what you get when capitalists control a market...

No, the problem here is that health care is profit driven instead of putting the health of the population first. When profit is one of your ends, every other priority becomes a means to that end. Everything else can be used, abused, exploited, and perverted to achieve profit. So you can never run a health care system that's predicated on profit; profit will always overrule people's health.

Re: Re: It's what you get when *CRONY*-capitalists control a market...

What makes you so sure that it's Medicare that's skewing the price of health care? When you have health insurance, you have no heuristic cost to paying for medical care and that makes us all rather numb to inflating health care costs. So long as our premiums don't increase drastically and our plans cover our care, we don't pay any mind to what prices the hospital charges for the care we receive. I think Medicare is just trying to keep up for the sake of those that can't afford privatized insurance.

Re: Re: It's what you get when capitalists control a market...

Tell me, what are those laws with which government has gotten involved to allow this to happen?? You're probably one of these deplorable people who benefits from these outrageous prices. Your argument assumes that insurance companies, pharmaceuticals, hospitals, and doctors aren't in it for nothing more than money and would lower the prices to normal levels if only the oppresive government would stop forcing us to keep prices so high because of regulations. You're a fucking idiot.

Re: Re: It's what you get when *CRONY*-capitalists control a market...

You do realized that you got everything wrong on this issue. The article specifically imply that hospital bill do not obey free market rules because for most part, customers are not voluntarily using the services of the hospital. In life and death situations, or doctor referrals, you do not get the bill until it is too late. Medicare actually pays much less to the hospital because it has clout to negotiate reasonable prices with the hospitals. The current prices are not "forced by the government through Medicare." The collective bargaining power of Medicare ensure the government and taxpayers were not ripped off. As for small insurance companies and individuals, the results are very different. Either you are insane or willfully ignoring the obvious or deliberately twisting the obvious truth to suit your narrow worldview, you are the the problem this country face; people with no critical thinking skills whatsoever pretending to be educated.

Re:

Re:

The abuses by the hospitals involved with fraud are actually contractually dealt with at the state level through companies that audit hospitals.

The problem is that Obama basically said that his new system was universal health care...along the lines of the UK...and that we shouldn't worry about it. It turns out that when you look at it, Obamacare is a Universal Health Insurance Plan...

Re: ObamaCare

I believe it

I had a lythotripsy (sp?) to break up a kidney stone a few years back. It was over $20,000 for a half day in out patient care. The procedure was about 20 minutes. The original bill was over $10,000 higher than that but was written down because I had insurance. So a guy with no insurance and probably no way to pay gets charged 50% more.

Also, compare that to the lythotripsy I had 10 years earlier at the same hospital with the same doctor for a mere $11,000.

Another reason why we haven't been able to get cheaper health care

American doctors are overpaid: Medicare is cheaper than private insurance because it pays doctors less and that’s great. - Slate Magazine: "... America has the highest-paid general practitioners in the world. And our specialists make more than specialists in every other country except the Netherlands. What’s even more striking, as the Washington Post’s Sarah Kliff observed last week, these highly paid doctors don’t buy us more doctors’ visits. Canada has about 25 percent more doctors’ consultations per capita than we do, and the average rich country has 50 percent more. This doctor compensation gap is hardly the only issue in overpriced American health care—overpriced medical equipment, pharmaceuticals, prescription drugs, and administrative overhead are all problems—but it’s a huge deal."

Re:

Because it shouldn't be considered a commodity. Healthcare should be considered a right. The entire system should be truly non-profit. If your incentive is profit and not "to improve" health, or have the best outcomes, it's inherently a conflict of interest. Simple. As it stands, profit is the incentive, and that is not best for patients. It's best for investors. The whole thing should be nationalized for damn sure.

Re: Re: Re:

Self diagnostic and treatment is the wave of the future. Its more than a trend. (Dump the DEA for their lifestyle enforcement stupidity)

The detail and (technical) knowledge of (the above makes) this comment is exceptional.

Health diagnistics and monitoring is becoming increasingly easily done with everyday devices like your cellphone and the only issues are ones of privacy (stand up for this) its best that we use a home computer rather than a smart(stupid)phone.

Re: So many discussions we're not having

I wonder if this is related...

Your local community property association possibly (likely?) (can I make a more disgusting example of a legal organization? -puke-) prohibits hanging your clothes out, (a wonderful way to save energy costs, prohibits putting up a TV antenna(I mean... really!) because its an eyesore, or painting a cool picture on your garage door (what is free expression anyway?),

We all want to live as long as we can providing functionable feedback to our kids (or (generally) generation). This is a “why we live, kind of, argument”. Do our individual actions mater? (Yeeeessssss!)

I have said this before: “what is the difference between THINKING and THOUGHT? (argue with me.)

Re: Not a free market? No, Duh!

There are areas (cities of 37,000 in 2007) that cannot build a hospital because of state mandated agencies that regulate medical facilities including emergency services. (Plainfield, IL) Seems that this 'authority' demanded that all medical facilities be built from a select (bribes and illicit contributions) few construction firms. (this authority was successfully prosecuted and its members thrown out)

And. What did the elected officials do? (after they were successfully prosecuted?) Thats right they RE-appointed the same president as before... (I mean REALLY... whats the use when voters are not paying attention.)

Billing Statement

While I generally agree with your entry, the billing statement is a bit misleading.

It's likely the invoice allows for "millions" to accommodate payments from large employers. For example, Boeing employs about 1,700 in Tacoma. If their monthly employee plan premiums range from $600 - $1,000, a realistic range for individual and family plans, their bill would exceed $1.0 million. I'm not saying that's a reasonable amount to pay - but it's realistic and Boeing isn't even Tacoma's largest employer.

Simple enough - bad goals, bad result.

Health care in America is simply wrong in its approach to providing it.

It's a complete fail in the basic philosophy of it. How badly it fails and in what way isn't even all that relevant unless you discuss how to fix the whole thing - sure you can try to treat the symptom like high bills (lord knows US healthcare is good at going for the symptom over the root illness, too) but if you do that instead of treating the illness you'll kill the patient.

Simply put: universal/single payer can be encapsulated with "High quality care for everyone as affordably as possible, but without penny-pinching it to death."

For-profit care? "Maximum money for every greedy hand in the chain, while producing some sort of care at the lowest attainable cost and quality possible in order to maximize the profit margin."

It's hardly surprising care in America is an ultra-expensive nightmare for a huge percentage of the population. As with everything else in a capitalistic state, a great many need to suffer so that a few can reap sickening profit.

Re: There are doctors fighting back.

This Reason article, like so many placed in the media by the heavily subsidized oil billionaire Koch brothers who fund Reason, is profoundly lousy with vile lies.

It posits the monstrously false choice between "efficiency" and the modern health care system. Fact: the single most efficient payer in health care is Medicare, running at 4% overhead. Fact: ACA imposes medical loss ratios onto insurance companies and caps them at 20% - a level that is five times higher than 4%, meaning private insurers previously couldn't even hope for anything resembling efficiency and had to be legislated to take efficiency seriously vs. shareholder profit. This fact means that this is not "doctors vs, Obamacare", it's Obamacare vs. making quite as much cash off sick people.

The article also posits the inhumane notion that sick people should be negotiating anything. This is a common position of people for whom no expense is to be spared and no financial distractions appear when they become sick. We call these people billionaires. We call the myopic who echo their worldview libertarians.

It falsely claims ACA drives people outside the regular market to find alternatives when what ACA does is create health insurance exchanges in the regular market that did not exist outside or inside it.

It goes on like that. Like Reason tends to do. Libertarian economics is nothing more than anarchy for rich people.

I have an idea

We...as in "We the people" here could organize, write our own mission statement. Then proceed to advocate through any and all possible legal activities to mandate all agencies, organizations, corporations that provide any healthcare service, to disclose itemized costs PRIOR to services rendered. In fact, each business CAN BE REQUIRED BY LAW to post these "itemized/procedure/supply/service cost list quarterly and through a public portal of some type. In this way, consumers can review this information and chose in advance where we will take our business if/when needed. A simple, clearly stated list of charges by category: supplies, tests, procedures, blood bank, medications, rooms per acuity and per 24 hour period. Now days, these mega-Goliath medical structures also employ the physicians too (even though the docs will send separate bill-something they have demanded to appear autonomous). So their "rounds", the ones that last 6 minutes, can be itemized by cost as well. ALL IT TAKES is a few of "We", a commitment, a mission, a plan and execution. This is a place to start. The mission can always be expanded to include other consecutive activities. Just an idea.

Re: Re: It's what you get when capitalists control a market...

Yes, you'd think that new hospitals would open and give existing ones a run for their money. The problem is, it's illegal. To open a new hospital you have to get a Certificate of Need, and the existing hospitals have a say in whether one is granted. Of course they are not keen on competitors entering their market.